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OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 


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STATE  NORMAL  SCHOOL 

LOS  ANGELES,  CALIFORNIA 


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in  2007  with  funding  from 

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http://www.archive.org/details/careofchildrenOOcottiala 


THE  LIBRARY 

OF 

HOME    ECONOMICS 

A  COMPLETE  HOME-STUDY  COURSE 

ON    THE    NEW    PROFESSION    OK    HOME-MAKING    AND    ART    OF    RIGHT    LIV- 
IKO  :     THE     PRACTICAL    APPLICATION     OF     THE     MOST     RECENT    AD- 
VANCES   IN    THE  ARTS   AND   SCIENCES  TO    HOME   AND   HEALTH 

PEEP  ABED  BY  TEACHERS  OF 
RECOGNIZED  AUTHORITY 

FOR      HOME-MAKERS,       MOTHERS,      TEACHERS,      PHYSICIANS,      NURSES, 
DIETITIANS,    PROFESSIONAL    HOUSE    MANAGERS,   AND   ALL   INTER- 
ESTED   IN    HOME,    HEALTH,    ECONOMY    AND    CHILDREN 

TWELVE  VOLUMES 

NEARLY    THREE   THOUSAND   PAGES,    ONE   THOUSAND   ILLUSTRATIONS 

TESTED    BY    USE    IN    CORRESPONDENCE    INSTRUCTION 

REVISED    AND    SUPPLEMENTED 


CHICAGO 

AMERICAN    SCHOOL   OF  HOME   ECONOMICS 

1911 


•^■501-V 


OOPTRIGHT,  1907 
BY 

Home  Economics  Association 

Entered  at  Stationers'  Hall,  London 

A 11  Rights  Reserved 


AUTHORS 


ISABEL  BEVIER,  Ph.  M. 


Professor  of  Household  Science,  University  of  Illinois.  Au- 
thor U.  S.  Government  Bulletins,  "Development  of  the  Home 
Economics  Movement,"  "Selection  and  Preparation  of  Food," 
etc.     President  American  Home  Economics  Association. 

ALICE  PELOUBET  NORTON,  M.  A. 

Assistant  Professor  of  Home  Economics,  School  of  Education, 
University  of  Chicago :  Director  of  the  Chautauqua  Schoel  of 
Domestic   Science ;   Author  "Teaching  of   Home   Economics." 

S.  MARIA  ELLIOTT 

Instructor  in  Home  Economics,  Simmons  College ;  Formerly 
Instructor  School  of  Housekeeping,  Boston. 

ANNA  BARROWS 

Teacher  of  Cookery,  Teachers'  College.  Columbia  University , 
Director  Chautauqua  School  of  Cookery ;  formerly  Editor 
"American  Kitchen  Magazine"  ;  Author  "Home  Science  Cook- 
Book." 

ALFRED  CLEVELAND  COTTON,  A.M.,  M.D. 

Professor  Diseases  of  Children,  Rush  Medical  College,  Uni- 
versity of  Chicago :  Vis'ting  Physician  Tresbyterian  Hos- 
pital, Chicago  ;  Author  of  "Diseases  of  Children." 

BERTHA  M.  TERRILL,  A.B. 

Professor  of  Home  Economies  and  Dean  of  Women,  Univer- 
sity of  Vermont ;  Author  of  U.  S.  Government  Bulletins. 

KATE  HEINTZ  WATSON 

Formerly  Instructor  in  Domestic  Economy,  Lewis  Institute ; 
Lecturer  University  of  Chicago. 

MARION  FOSTER  WASHBURNE 

Editor  "The  Mothers'  Magazine ;''  Lecturer  Chicago  Froebel 
Association ;  Author  "EVerydny  Essays,"  "Family  Secrets," 
etc. 

MARGARET  E.  DODD 

Graduate  Massachusetts  Institute  of  Technology ;  Teacher  of 
Science,  Woodward  Institute. 

AMY  ELIZABETH  POPE 

With  the  Panama  Canal  Commission ;  Formerly  Instructor 
in  Practical  and  Theoretical  Nursing,  Training  School  for 
Nurses,  Presbyterian  Hospital,  New  York  City. 

MAURICE  LE  BOSQUET,  S.  B. 

Director  American  School  of  Home  Economics :  Member 
American  Public  Health  Association  and  American  Chemical1 
Society.  :*    ■  -'*-....- 


Biomedical 
W 

\90l 


CONTRIBUTORS  AND  EDITORS 


ELLEN  H.  RICHARDS 

Author  "Cost  of  Food,"  "Cost  of  Living,"  "Cost  of  Shelter." 
"Food  Materials  and  Their  Adulteration,"  etc.,  etc. ;  Chair- 
man Lake  Placid  Conference  on  Home  Economics. 

MARY  HINMAN  ABEL 

Author  of  U.  S.  Government  Bulletins,  "Practical  Sanitary 
and  Economic  Cooking,"  "Safe  Food,"  etc. 

THOMAS  D.  WOOD,  M.  D. 

Professor  of  Physical  Education,  Columbia  University. 

H.  M.  LUFKIX,  M.D. 

Professor  of  Physical  Diagnosis  and  Clinical  Medicine,  Uni- 
versity of  Minnesota. 

OTTO  FOL1X,  Ph.D. 

Special  Investigator,  McLean  Hospital,  Waverly,  Mass. 

T.  MITCHELL  PRUDDEX,  M.  D.,  LL.  D. 

Author  "Dust  and  Its  Dangers,"  "The  Story  of  the  Bac- 
teria,"  "Drinking  Water  and  Ice  Supplies,"  etc. 

FRANK  CHOUTEAU  BROWN 

Architect,  Boston,  Mass. :  Author  of  "The  Five  Orders  of 
Architecture,"   "Letters  and   Lettering." 

MRS.  MELVIL  DEWEY 

Secretary  Lake  Placid  Conference  on  Home  Economics. 

HELEN  LOUISE  JOHNSON 

Professor  of  Home  Economics,  James  MUlikan  University, 
Decatur. 

PRANK  W.  ALLIN,  M.  D. 

Instructor  Rush  Medical  College,  University  of  Chicago. 


MANAGING  EDITOR 

MAURICE  LE  BOSQUET,  S.  B. 

Director  American  School  of  Home  Economics. 


BOARD  OF  TRUSTEES 

OF    THE    AMEBICAN    SCHOOL   OF    HOME    ECONOMICS 


MRS.  ARTHUR  COURTENAY  NEVILLE 
President  of  the  Board. 

MISS  MARIA  PARLOA 

Founder  of  the  first  Cooking  School  in  Boston ;  Author  of 
"Home  Economics,"  "Young  Housekeeper,"  U.  S.  Govern- 
ment Bulletins,  etc. 

MRS.  MARY  HINMAN  ABEL 

Co-worker  in  the  "New  England  Kitchen,"  and  the  "Rum- 
ford  Food  Laboratory  ;"  Author  of  U.  S.  Government  Bul- 
letins, "Practical  Sanitary  and  Economic  Cooking,"  etc. 

MISS  ALICE  RAVENHILL 

Special  Commissioner  sent  by  the  British  Government  to  re- 
port on  the  Schools  of  Home  Economics  in  the  'United 
States  ;  Fellow  of  the  Royal  Sanitary  Institute,  London. 

MRS.  ELLEN  M.  HENROTIN 

Honorary   President  General   Federation   of  Woman's   Clubs. 

MRS.  FREDERIC  W.  SCHOFF 

President  National   Congress  of   Mothers. 

MRS.  LINDA  HULL  LARNED 

Past  President  National  Household  Economics  Association ; 
Author  of  "Hostess  of  To-day." 

MRS.  WALTER  McNAB  MILLER 

Chairman  of  the  Pure  Food  Committee  of  the  General 
Federation  of  Woman's  Clubs. 

MRS.  J.  A.  KIMBEELY 

Vice  President  of  National  Household  Economics  Associa- 
tion. 

MBS.  JOHN  HOODLESS 

Government  Superintendent  of  Domestic  Science  for  the 
province  of  Ontario :  Founder  Ontario  Normal  School  of 
Domestic  Science,  now  the  MacDonald  Institute. 


COPYRIGHT,    1903,  BV   LA    ROCHE,    SEATTLE 


AN  INDIAN  BABY 
Takima  Papoose 


Care  of  Children 


BY 

ALFRED  CLEVELAND  COTTON,  A.  M.(  M.  D. 

PROFESSOR  DISEASES  OF  CHILDREN 

RUSH   MEDICAL  COLLEGE,  UNIVERSITY  OF  CHICAGO 

ATTENDING   PHYSICIAN   DISEASES  OF  CHILDREN 

PRESBYTERIAN  HOSPITAL 


-2-50  I  4- 


CHICAGO 

AMERICAN  SCHOOL  OF  HOME  ECONOMICS 

1911 


£^014 


COPYRIGHT,  1906   BY 
HOME  ECONOMICS  ASSOCIATION 

Entered  at  Stationers  Hall,  London 
Ail  Rights  Reserved 


C£? 


0  \ 


CONTENTS 


Letter  to  Students 

Hygiene  of  the  Baby 

New  Born  Baby 

Care  of  the  New  Baby 

Baby's  Clothes 

Clothing  for  Older  Children 

Surroundings  and  Care  . 

Sleep  .  . 

Exercise  .... 

Bathing  .... 

Regulation     .... 

Development  and  Growth 

Teething  .... 

Development  of  Special  Senses 

Nutrition  of  the  Child   . 

Natural  Food 

Weaning  and  Substitute  Feeding 

Artificial  Feeding 

Modified  Milk 

Foods  Other  Than  Milk 

Food  Disorders 

Food  after  the  First  Year 

Food  Recipes  .... 

The  Sick  Child 

The  Cry  .... 

Colic  ..... 

Constipation    .... 

Summer  Diarrheas 

Apnormal  Passages 

Rickets,  Malnutrition,  Scurvy    . 

Colds       . 


v 

i 

6 

IS 

20 

3° 
32 
34 
37 
38 
39 
42 
47 
5o 
55 
56 

7i 
76 
90 
109 
"3 
ii5 
119 
123 

125 
127 
128 
130 
134 
136 
141 


CONTENTS 


Sore  Throat         .... 

Croup 

Temperature        .... 

Nervous  Disorders 

Convulsions,  Spasms,  Fits,  Cramps 

Contagious  Diseases 

Measles        ..... 

Scarlet  Fever 

Chicken  pox         .... 

Diphtheria       .... 

Whooping  Cough 

Foreign  Bodies 

Earache       ..... 

The  Medicine  Chest 

Hygiene  of  the  Child  and  Youth 

Education        .... 

Pubescence  .... 

Bibliography  . 

Sodium  Citrate  in  Infant  Feeding 

The  Soother   .... 

Program  for  Supplemental  Study 

Index   .'.... 


I  |  3 

'45 
M7 
148 
149 
153 
*54 
155 
156 
*57 
158 

159 
160 
163 
165 
167 
171 

174 
179 
192 
201 
205 


AMERICAN  SCHOOL  OF   HOME   ECONOMICS 
CHICAGO 

January  1,  1907. 

My  dear  Madam: 

In  my  private  practice  I  meet 
so  many  mothers,  well  educated  otherwise,  who 
are  profoundly  ignorant  of  the  care  of  children 
that  it  is  a  pleasure  to  find  one  who  is  willing 
to  study  something  of  the  subject  in  a  systemat- 
ic way. 

The  feeding  cf  children,  especially  of 
bottle  babies,  calls  for  the  utmost  skill  of  the 
trained  physician,  while  the  responsibility  of 
a  sick  child  is  too  great  for  any  mother  or 
nurse. 

It  goes  without  saying  that  a  subject 
which  oft  times  taxes  the  knowledge  of  exper- 
ienced physicians  cannot  be  mastered  in  a  few 
short  lessons  by  the  average  mother.  It  is  only 
in  the  hope  that  some  of  the  fundamental  prin- 
ciples embodied  herein  may  be  impressed  upon  the 
student  mother's  mind  and  lead  to  a  better  appre- 
ciation of  the  importance  of  details  in  the  man- 
agement of  the  child  that  these  lessons  are  of- 
fered. 

Children  are  not  alike,  nor  can  they  be 
classified  according  to  their  peculiarities 
with  a  view  to  successful  care  or  treatment  of 
their  varying  disorders.  Each  child  has  his 
particular  individuality,  study  and  appreciation 
of  which  marks  the  highest  type  of  the  success- 
ful physician.   The  name  of  the  disease  or  dis- 
order is  usually  of  less  importance  than  the  in- 
dividuality or  peculiarity  of  the  child. 

The  dosing  cf  children  according  to  any 
stereotyped  formula  for  real  or  imaginary  ail- 


ments  cannot  be  too  vigorously  condemned  and 
the  wise  mother  will  rarely  administer  medi- 
cines except  under  the  advice  of  the  physician. 

Prevention  is  always  much  easier  than  cure 
and  a  mother's  greatest  opportunity  comes  in 
so  caring  for  her  child  that  he  may  seldom  re- 
quire the  services  of  the  physician. 

I  regret  that  I  shall  not  be  able  to  §ive 
the  time  to  look  over  your  answers  personally, 
but  my  assistant  will  call  upon  me  freely  and 
I  shall  be  glad  to  give  any  personal  assistance 
that  I  can. 

Very  truly  yours, 


THE  FOLLOWING  ARE  A  FEW  PAGES  FROM  THE  LESSONS 


ONE  OF  DR.  COTTON'S  BABIKS   IX  THE  "BABY  RAG' 


CARE    OF    CHILDREN 


Hygiene  ot  the  Baby 


T 


HE  care  of  the  infant  should  begin  from  the 
moment  of  conception.  So  much  does  the 
normal  development  of  the  unborn  child  depend 
upon  the  physical  vigor  and  mental  balance  of  the 
mother  that  her  health  during  pregnancy  is  of  the 
highest  importance.  Everything  that  tends  to  im- 
prove the  mental  and  physical  condition,  such  as 
wholesome  food,  pleasant  surroundings,  congenial 
associates,  exercise,  fresh  air  and  sunshine  should 
be  secured  for  the  expectant  mother. 

Under  favorable  hygiene  even  the  very  delicate 
woman  may  bear  and  nourish  healthy  children. 

During  pregnancy,  especially  in  the  advanced 
stage,  laborious  occupation  and  violent  exercise 
must  be  avoided.  The  exercise  involved  in  walking 
and  in  the  duties  of  light  housework  is  beneficial 
while  the  exertion  incident  to  laundry  work,  pro- 
longed use  of  the  sewing  machine,  hill  climbing 
and  driving  over  rough  roads  may  be  positively 
injurious  or  even  dangerous. 

Corsets  should  be  discarded  upon  the  first  evi- 
dence of  conception  and  loose  clothing  suspended 
from  the  shoulders  should  be  adopted,  thus  reliev- 
ing the  hips  and  abdomen  of  all  weight  and  com- 
pression. The  ideal  dress  for  this  period  is  the  union 


Care  of 
the  Baby 
Before 
Birth 


Jare  of 
the  Mother 


Drsss 


CARE  OF  CHILDREN 


A  PRINCESS  MATERNITY  GOWN 

Ladies'  Home  Journal  Pattern. 


BEFORE  THE  BABY  COMES 


suit,  a  light  petticoat  fastened  to  a  loose  waist  and 
an  empire  gown.  In  cold  weather  wool  tights  may 
be  worn  instead  of  additional  skirts. 

The  process  of  making  blood  and  tissue  for  the 
unborn  as  well  as  for  the  mother  makes  heavy  de- 
mands upon  her  vital  energy,  hence  not  only  in- 
creased nourishment  is  necessary  but  extra  sleep, 
so  that  a  daily  nap  should  be  secured  unless  it  inter- 
feres with  the  sleep  at  night.  A  liberal  supply  of 
substantial  but  easily  digested  food  should  be  pro- 
vided and  the  appetite,  if  sluggish,  stimulated  by 
outdoor  exercise  and  tempting  dishes.  Fresh  fruits 
and  vegetables  in  season  should  form  part  of  the 
dietary  in  the  absence  of  which  canned  vegetables 
and  stewed  fruits  may  be  substituted.  A  heavy  diet 
of  meats  and  rich  foods  which  overtax  the  digestion 
should  be  avoided. 

The  tendency  to  constipation  at  this  time  may 
usually  be  relieved  by  a  generous  supply  of  juicy 
fruits  and  the  coarser  cereals,  such  as  oat  meal,  corn 
meal,  graham,  whole  wheat  and  brown  bread. 

The  nausea  and  vomiting  (morning  sickness)  so 
common  during  the  first  months  of  this  interesting 
condition  may  occasionally  be  relieved  by  a  cup  of 
hot  coffee  or  broth  taken  before  rising.  Dry  mag- 
nesia will  frequently  relieve  heart  burn  (sour  stom- 
ach) and  may  act  as  a  mild  laxative.  If  constipation 
be  obstinate  a  daily  enema  of  from  one  to  three 
pints  of  soapy  water  may  be  necessary. 


Food  for 
the  Mother 


Morning1 
Sickness 


4  CARE  OF  CHILDREN 

Gentle  massage  of  the  abdomen  with  olive  oil, 
cocoa  butter  or  goose  fat  should  be  practiced  daily, 
not  only  for  its  nutritious  effect  but  to  facilitate 
stretching  of  the  tense  skin.  If  the  womb  drags 
heavily  upon  the  abdomen  great  relief  may  be  ob- 
tained by  a  properly  adjusted  supporter  so  arranged  # 
as  to  support  the  lower  part  of  the  abdomen. 
The,  Breasts  The  breasts  so  essential  to  the  future  sustenance 
of  the  child,  should  be  treated  daily  to  the  same 

gentle  massage  while  the 
nipples  should  be  gradu- 
ally toughened  by  the  ap- 
plication of  dilute  alcohol 
or  equal  parts  of  brandy 
and  water.  If  flat  or  de- 
an  abdominal  supporter,  pressed  the  nipples  should 
From  Griffith.  \^e  developed  by  moulding 

with  the   fingers  or  drawing   out   with    a    cupping 
glass  or  breast  pump. 

Swelled  feet  and  distended  veins  of  the  legs  may 
be  due  to  pressure  of  the  heavy  womb  and  require 
frequent  rest  in  the  horizontal  position  with  the 
feet  elevated,  while  the  limbs  are  gently  stroked 
towards  the  body.  In  severe  cases  bandaging  may 
be  necessary  which,  however,  should  always  be 
done  under  the  advice  of  the  physician. 
The  urine  A  specimen  of  the  urine  should  be  furnished  the 
doctor  from  time  to  time  for  examination,  especially 
during  the  later  months  of  pregnancy,  as  dangerous 


BEFORE  THE  BABY  COMES 


kidney  complications  may  be  thereby  discovered 
and  relieved  by  timely  treatment. 

The  teeth,  which  frequently  soften  and  decay  dur- 
ing pregnancy,  should  be  put  in  first  class  condition 
by  the  dentist  during  the  early  months,  thus  pre- 
venting much  suffering  and  maybe  serious  shock. 

The  expectant  mother  should  regard  the  coming 
of  her  baby  with  feelings  of  happy  anticipation 
while  dread  of  the  ordeal  should  be  kept  sedulously 
in  the  background.  All  means  for  promoting  happi- 
ness and  contentment  should  be  cultivated  as  de- 
spondency, dread  and  discontent  not  only  interfere 
with  the  mother's  physical  well-being  but  may  tend 
to  arrest  or  pervert  development  of  the  unborn 
child. 

The  popular  belief  in  birth  marks  as  a  result  of 
disagreeable  or  unusual  occurrences  or  sights  is  not 
well  founded,  but  the  hygiene  of  this  period  requires 
that  the  mother  be  protected  from  undue  mental 
strain  or  intense  emotional  disturbances. 

All  preparation  for  the  advent  of  the  little  one 
should  be  simple,  rational  and  complete  long  before 
the  last  weeks  of  pregnancy  thereby  avoiding  the 
undue  work  and  worry  of  hasty  preparation. 

The  pregnant  woman  should  be  under  the  care  of 
a  competent  physician  during  the  entire  period  of 
gestation. 

Since  not  only  the  life  of  the  infant  but  his  entire 


The  Teeth 


Mental 
Conditions 


Preparations 


Importance 
of  Early 
Care 


6  CARE   OF  CHILDREN 

future  health  is  dependent  upon  the  nature  of  his 
early  care,  intelligent  study  of  all  that  pertains  to 
the  hygiene  of  this  little  being  is  the  highest  duty 
of  the  young  mother.  The  belief  that  instinct  en- 
dows motherhood  with  knowledge  requisite  to  her 
new  responsibilities  is  not  only  erroneous  but  pro- 
ductive of  great  mischief,  as  the  lost  or  ruined  lives 
of  thousands  of  mismanaged  infants  will  attest. 
Imof°infant  Viewed  in  this  light  a  knowledge  of  the  slightest 

Hygiene  details  of  the  infant's  anatomy,  physiology  and 
hygiene  assumes  a  new  significance  and  may  prove 
of  inestimable  value  in  conserving  his  health  and 
insuring  his  normal  development.  The  startling 
death  rate  in  early  infancy  calls  loudly  for  a  more 
thorough  study  of  the  causes  of  poor  development 
and  disease  most  of  which  might  be  prevented  by 
a  better  understanding  of  the  infant  and  his  re- 
quirements. It  is  evident  that  the  simplest  method 
of  studying  the  new  born  infant  is  to  become  famil- 
iar with  the  details  of  his  normal  form  and  propor- 
tions, for  in  this  way  only  may  departures  from  the 
normal  be  recognized. 

THE  NEW  BORN  BABY 

skin  The  infant's  skin  at  birth  is  usually  covered  with 
a  thick  whitish  substance  (vernix  caseosa)  which 
is  most  abundant  in  the  creases  and  depressions  and 
upon  the  scalp.  At  birth  the  color  is  a  dusky  hue, 
which  after  a  few  full  inspirations  changes  to  the 


TWO  NEW  BORN  BABIES 


BACK 

/"^ 

FROM 

r 

0 

i 

0 

X 

0 

r, 

M 

10 

1 

9 
2 

r — 

«A 

INCH 

SS  WI 

DE 

PATTERN  FOR  A  SIMPLE  MUSLIN  SLIP. 

Draw  2-inch  squares  on  a  paper  over  36  in.  x  16  in.  and  sketch  the 
pattern  as  indicated.  The  gown  is  gathered  at  the  neck  and  wrists 
on  very  narrow  bands.  The  back  is  like  the  front  except  at  the  neck. 
(Only  the  top  and  bcttom  of  the  pattern  is  shown.) 


THE  NEW  BORN  BABY  9 

"boiled  lobster"  red.  About  the  third  day  a  scaling 
of  the  skin  begins,  which  continues  for  a  week  or 
ten  days.  The  texture  of  the  skin  is  very  delicate 
and  is  usually  covered  with  a  downy  growth,  called 
lanugo. 

The  average  weight  at  birth  is  about  7  pounds  for 
boys  and  6  pounds  for  girls.  The  average  length 
is  from  18  to  20  inches. 

To  anyone  seeing  a  new-born  infant  for  the  first 
time,  the  large  head,  small  chest,  enormous  abdo- 
men and  insignificant  extremities  seem  out  of  all 
proportion. 

A  constant  proportional  relationship  exists  be- 
tween the  different  members  of  the  normal  infant 
at  birth.  The  following  simple  rule  will  aid  the 
student  in  remembering  this  relationship. 

Rule. — Add  4  inches  to  half  the  baby's  length  for 
the  chest  circumference ;  the  head  is  one  inch  larger 
than  the  chest.  The  abdomen  is  J/2  to  1  inch  larger 
than  the  head,  e.  g. : 

Length 18  inches 

Circumference  of  thorax 13  inches 

Circumference  of  head 14  inches 

Circumference  of  abdomen 14%  inches 

The  head,  being  plastic,  shows  the  pressure  effects 
of  recent  birth.  If  labor  has  been  prolonged  it 
sometimes  presents  a  great  elongation  and  not  in- 
frequently there  is  a  soft  doughy  swelling  as  large 
as  half  an  orange  near  the  crown  caused  by  the 


Weight 


Proportions 


The  Head 


io  CARE  OF  CHILDREN 

recent  pressure.     By  the  end  of  the  first  week  the 
head  should  have  resumed  its  normal  shape. 
Fonuneiiei  Adjacent  margins  of  the  bones  of  the  head  are 

separated  by  fibrous  tissue  continuous  with  the  lin- 


SKULL  OF  AN  INFANT,  SHOWING  FONTANELLES. 

ing  internally  and  the  covering  externally.  At  the 
places  where  three  or  more  bones  should  come  to- 
gether are  soft  spaces  called  fontanelles.  The  larg- 
est and  most  important  of  these  is  situated  at  the 
top  of  the  head  well  to  the  front,  and  is  often  called 
the  "soft  spot".  In  this  space  there  is  a  regular 
pulsation  corresponding  in  frequency  with  the  heart 


THE  NEW  BORN  BABY 


beats.  The  fontanelles  should  be  carefully  guarded 
against  injury. 

The  softness  and  elasticity  of  the  bones  of  infancy 
are  due  to  their  vascularity,  the  sponginess  of  their 
texture,  and  from  the  layers  of  cartilage  and  mem- 
brane not  yet  ossified. 

The  true  bony  structure  of  the  new  born  baby 
corresponds  to  the  needs  of  the  infant,  e.  g.,  the 
bones  of  the  lower  jaw  and  ribs  and  collar  bone 
which  renders  possible  respiration  and  suction  from 
birth,  are  well  developed. 

Over  the  cheek  muscles,  in  addition  to  the  ordi- 
nary layer,  of  fat,  there  is  an  arrangement  of  fatty 
lobules  on  either  side,  called  "sucking  cushions" 
because  they  prevent  the  cheeks  being  pressed  in- 
ward between  the  jaws  when  nursing. 

The  eye  at  birth  is  anatomically  incomplete, 
which  would  prevent  perfect  sight  even  if  the  brain 
were  ready  to  receive  -  and  interpret  impressions. 
The  color  of  the  iris  is  a  bluish  gray  and  the  pupils 
are  large  and  sensitive  to  light. 

The  lachrymal  glands  are  not  fully  developed, 
hence  no  tears  before  the  third  month. 

The  nose  is  relatively  small,  and  the  respiratory 
portion  is  very  small. 

The  tongue  is  rarely  the  seat  of  congenital  defect 
and  tongue  tied  babies  are  not  often  seen. 

The  spine  of  the  infant  is  extremely  flexible.  It 
is,  in  fact,  almost  wholly  cartilaginous  at  birth,  the 


Bones 


Sucking 
Cushions 


The  Eyes 


The  Spina 


12 


CARE  OF  CHILDREN 


Blood 
Supply 


centers  of  ossification  being  present  but  the  process 
only  slightly  advanced. 

The  collar  bone  is  the  first  bone  of  the  skeleton 
to  ossify  and  is  more  frequently  fractured  during 
delivery  and  in  early  childhood  than  is  any  other 
bone. 
The  Lungs  Rapid,  and  remarkable  changes  occur  in  the  lungs 
after  birth.  During  the  first  inspiration  compara- 
tively little  air  is  taken  into  the  lungs  but  as  one 
full  inspiration  follows  another,  inflation  increases 
more  and  more  until  full  distension  is  accomplished 
after  which  the  lungs  are  never  completely  emptied 
of  ,air  during  life. 

Growth  and  action  of  all  the  organs  are  entirely 
dependant  on  the  blood  supply.  As  the  blood  sup- 
ply not  infrequently  depends  upon  the  muscular 
activity  of  the  parts,  it  is  plain  that  restrained 
activity  or  interference  with  circulation  by  any 
means  retards  both  function  and  growth.  In  the 
care  of  the  young  infant  too  much  stress  can  not 
be  laid  upon  the  importance  of  freedom  of  motion 
for  all  the  members,  and  avoidance  of  anything  that 
tends  to  compress  the  vessels,  such  as  long  con- 
tinued lying  in  one  position,  with  possibly  the  addi- 
tion of  blood  stagnation  in  the  dependent  parts.  In 
this  respect,  also,  the  clothing  requires  that  no  bands 
nor  seams  may  press  upon  the  vessels  of  ditribution 
or  the  return  supply  of  blood. 
Respiration  From  birth  to  death  the  oxygen  necessary  for  the 

vitality   of   the   body   is   supplied   through    the   air 


THE  NEW  BORN  BABY 


13 


vesicles  of  the  lungs.  If  any  vital  process  is  pre- 
eminent in  its  importance,  it  is  that  of  respiration. 
Young  children  inhale  more  oxygen  and  exhale 
more  carbon  dioxide,  relatively,  than  adults.  This 
is  a  result  of  the  more  rapid  tissue  change  in  the 
growing  organism. 

As  respiration  begins  only  after  birth  it  is  prob- 
ably the  least  developed  of  the  vital  functions.  Its 
want  of  vigor  is  partly  due  to  compressibility  of 
the  chest  walls,  to  the  lack  of  full  development  of 
the  respiratory  muscles  and  partly  to  the  narrow- 
ness of  the  upper  air  passages.  Care  of  the  nose  and 
throat  is  necessary  to  prevent  accumulations  or 
growths  which  interfere  with  the  free  entrance  of 
air. 

The  average  rate  of  respiration  is  from  30  to  60 
per  minute  and  during  the  early  months  may  be  very 
irregular. 

The  yielding  character  of  the  chest  renders  the 
•baby  very  susceptible  to  disturbances  by  compres- 
sion, so  that  great  care  should  be  exercised  not  only 
in  the  handling  of  the  infant  but  also  in  the  clothing 
so  that  no  constriction  of  the  chest  be  allowed. 

The  glands  of  the  mouth  of  the  new  born  secrete 
mucus  which  serves  for  protection.  The  salivary 
secretion  is  established  but  feebly  and  possesses 
little,  if  any,  power  of  changing  starch  to  sugar. 

The  stomach  at  birth  secretes  pepsin  in  very 
small  quantity  and  at  this  early  age  is  more  of  a 


Chest 


Digestive 
Organs 


14  CARE  OF  CHILDREN 

receptacle  for  food  than  a  digestive  organ.  Coagu- 
lation of  milk  by  the  rennet  ferment  represents 
nearly  the  whole  extent  of  its  digestive  function. 

Shortly  after  birth  meconium  (a  viscid,  tarry, 
odorless  substance)  is  discharged  from  the  bowels. 
This  continues  until  the  feces  are  changed  to  a 
canary  yellow  by  the  taking  of  milk. 

Urine  is  normally  present  in  the  bladder  at  birth 
and  is  usually  voided  within  a  short  time,  any  delay 
beyond  twelve  hours  causing  some  anxiety.  The 
urine  should  be  pale  and  odorless  but  it  may  con- 
tain uric  acid  crystals  which  stain  the  diaper  like 
iron  rust  and  are  sometimes  so  abundant  as  to 
completely  obstruct  the  small  tubes  of  the  kidneys. 
This  uric  acid  is  a  frequent  cause  of  colic  in  the 
new  born, 
care  of         The  delicate  skin  of  the  infant  demands  constant 

the  Skin 

care  to  prevent  irritation  and  excoriations  especially 
about,  the  buttocks,  from  the  urine  and  feces.  It 
seems  hardly  necessary  to  remark  that  the  diaper 
should  always  be  removed  as  soon  as  it  is  wet  or 
soiled  and  should  never  be  used  the  second  time 
without  thorough  washing. 
Nervous         In  regard  to  the  functions  of  the  nervous  system 

System  ° 

it  may  be  said  that  at  birth  the  infant  is  merely  a 
bundle  of  reflexes.  Such  reflex  action  however  as 
respiration,  swallowing,  winking,  coughing,  sneez- 
ing, clinging,  etc.,  shows  a  remarkable  pre-natal 
development  of  mechanism. 


CARE  OF  THE  NEW  BABY  15 

The  sense  of  hearing  is  probably  not  present  at      Special 

Senses 

birth,  but  is  established  within  the  first  day  or  two, 
as  the  middle  ear  fills  with  air  and  the  congestion 
of  its  mucous  membrane  subsides. 

In  all  probability  smell  is  the  last  of  the  special 
senses  to  develop. 

The  sense  of  taste  is  evidently  well  developed 
from  birth,  the  young  infant  readily  distinguishing 
milk  from  water. 

Tactile  sensation  is  very  acute  in  the  lips,  tongue 
and  eyes,  although  feebly  developed  in  other  areas. 

CAEE  OF  THE  NEW  BABY 

The  newborn  is  entirely  at  the  mercy  of  his  sur- 
roundings. In  fact,  of  all  the  mammalia,  the  human 
infant  is  the  most  helpless. 

Immediately  upon  delivery  the  baby  should  be  First 
wrapped  in  a  warm  soft  shawl  or  blanket.  The  eyes, 
mouth  and  nose  should  be  thoroughly  cleansed  of  se- 
cretions by  the  gentle  application  of  sterilized  gauze  or 
cheesecloth  dipped  in  tepid  boric  acid  solution.  A 
saturated  solution  of  boric  acid  in  boiling  water,  care- 
fully strained,  cooled  and  bottled  should  be  a  part  of 
the  equipment  of  the  confinement  room  and  nursery; 
also  a  supply  of  sterilized  gauze  or  cheesecloth  cut  in 
three-inch  squares  and  kept  in  sterilized  wrapping.  To 
sterilize  the  cheesecloth  or  gauze  it  should  be  kept  in 
boiling  water  for  forty  minutes,  dried  in  an  oven  and 
at  once  wrapped  in  a  sterilized  cloth  or  wrapping. 


Cleansing' 


c6  CARE  OF  CHILDREN 

Care  of  The  eyes  should  be  cleansed  with  separate  pieces  of 
gauze  moistened  with  the  boric  solution  by  pouring 
from  the  bottle.  If  a  few  drops  of  the  solution  find 
their  way  between  the  lids  so  much  the  better. 

The  mouth  may  be  freed  of  mucus  by  wrapping  the 
finger  in  dry  sterilized  gauze  and  gently  wiping  out  the 
secretion,  after  which  the  mouth  should  be  washed 
with  the  boric  acid  solution.  Then  it  is  well  to  give  the 
baby  a  teaspoonful  or  two  of  pure  tepid  water. 
Gentleness  If  necessary  to  free  the  nose  from  secretions  it  may 

be  done  by  gently  squeezing  it  between  the  thumb  and 
finger  from  the  top  down,  after  which  the  solution 
should  be  applied  on  a  piece  of  twisted  gauze.  Ex- 
treme gentleness  must  be  observed  in  these  manipula- 
tions so  as  to  leave  no  wound  or  abrasion  upon  the 
delicate  tissues  which  may  give  entrance  to  infective 
germs.  The  nurse's  hands  and  nails  should  be  cleansed 
beyond  suspicion 
Care  of  The  cor<^  may  ^)e  ireety  dusted  with  pulverized  boric 
the  cord  acj(j  an(j  covereci  with  dry  absorbent  cotton.  Placing 
the  baby  on  the  right  side  favors  the  new  course  of 
blood  through  the  heart. 

The  vernix  caseosa  with  which  the  new  born  baby 
is  usually  covered  is  best  removed  by  a  thorough  rub- 
bing with  warm  olive  oil,  or  fresh  lard,  which  forms 
with  it  a  soft  lather  and  is  easily  removed  by  gentle 
wiping  with  dry  soft  gauze.  The  next  day's  oiling  and 
wiping  will  remove  from  the  creases  and  folds  what 


CARE  OF  THE  NEW  BABY 


17 


little  of  the  substance  may  have  escaped  the  first 
cleansing. 

On  the  question  of  the  first  bath  there  is  a  decided 
difference  of  opinion".  Considering  the  temperature 
from  which  the  new  comer  has  emerged  (ioo°  F.), 
the  transition  to  room  temperature  even,  780  F. 
would  seem  to  be  sufficiently  stimulating.  There  is  a 
growing  opinion  in  favor  of  delaying  the  bath,  and  the 
writer  believes  with  others  that  this  first  water  bath 
should  not  be  given  for  several  days  after  birth.  A 
daily  rubbing  with  warm  olive  oil  is  to  be  preferred  as 
affording  less  danger  of  shock. 

The  baby's  brief  toilet  completed,  the  dressed  navel 
supported  by  a  light  flannel  band,  he  should  be 
wrapped  in  a  fresh  dry  blanket  and  allowed  to  sleep 
in  a  warm,  dark,  quiet  place  for  three  hours,  after 
which  he  may  be  given  another  drink  of  pure  water. 

It  is  advisable  to  place  the  infant  at  the  breast 
within  a  few  hours  after  birth  as  it  is  believed  that 
the  colostrum  or  first  milk  secreted  is  adapted  to  the 
needs  of  the  infant's  digestive  tract.  The  mother's 
nipples  and  the  baby's  mouth  should  be  previously 
cleansed  with  boric  acid  solution. 

An  infant's  needs  are  few  but  imperative.  They  are 
//■' / rmth,  food  and  repose.  It  should  be  disturbed  only 
when  necessary  for  drink,  for  its  daily  baths,  change 
of  clothing,  or  for  fresh  diapers.  It  should  be  nursed 
every  two  hours  during  the  day  and  once  at  night. 


First 
Bath 


First 
Nursing 


Imperative 
Needs 


18  CARE  OF  CHILDREN 

The  child  should  not  sleep  with  the  mother  or  nurse, 
hut  in  its  own  crib  or  basket  from  the  first, 
shock  Too  much  stress  cannot  be  laid  upon  the  avoidance 

of  all  that  tends  to  shock  or  fatigue,  and  the  observance 
of  absolutely  antiseptic  details.  Could  nurses  and 
mothers  realize  the  need  of  absolute  rest  for  the  new 
born,  the  advent  of  the  baby  would  not  be  the  signal 
for  the  "rough  house"  procedures  so  frequently  seen, 


General 
Water 


A  RUBBER  BATH  TUB. 

in  the  bath  attended  by  admiring  relatives,  the  dressing 
in  unsuitable  garments,  and  the  frequent  exhibitions  of 
the  baby  to  delighted  neighbors  and  caressing  friends. 

First  The  first  general  water  bath  may  be  given  to  vigor- 
ous babies  the  fifth  or  sixth  day,  after  which  it  may  be 

Bath  a  part  of  the  daily  toilet.  In  cases  of  premature  or 
very  feeble  infants  the  tub  bath  should  be  postponed 
until  there  is  no  danger  from  shock  or  chill.    The  early 


CARE  OF  THE  NEW  BABY 


19 


A  Double  Ewer  for  Hot  and  Cold  Water. 


bathing  should  be  done  with  the  baby  on  the  nurse's 
lap,  protected  from  drafts  by  a  soft  blanket.  Each 
part  should  be  gently  bathed  with  a  cheese  cloth 
sponge  and  quickly  dried  by  patting  with  a  dry,  warm 
towel  of  the  same  material.  New  cheese  cloth  for 
this  purpose  may  be 
rendered  absorbent 
by  thorough  boiling 
in  soda  water,  fol- 
lowed by  careful 
rinsing.  The  animal 
sponges  should  not 
be  used  as  they  can- 
not be  properly 
cleansed  and  quickly 

become  breeding  places  for  germs  of  many  kinds.  A 
full  tub  bath  should  not  be  given  until  the  cord  has 
come  off. 

A  good  quality  of  castile  soap  is  probably  the  best 
to  use,  for  many  of  the  so-called  "baby  soaps"  are  too 
irritating  for  the  infant's  delicate  skin.  After  drying 
the  creases  may  be  lightly  dusted  with  a  reliable  baby 
powder,  using  a  box  with  a  finely  perforated  top  for 
this  purpose.  The  ordinary  puff  ball  and  powder  box 
should  not  be  used  because  they  are  so  easily  con- 
taminated with  dust  laden  with  bacteria. 

Unremittent  care  is  required  to  prevent  accumula- 
tions on  the  scalp.  If  crusts  are  once  formed  they  must 
be  softened  by  frequent'  applications    of    warm    oil. 


Soap 


Care  of 
the  Scalp 


20 


CARE  OF  CHILDREN 


They  should  never  be  removed  by  use  of  the  fine  tooth 
comb,  in  fact  a  comb  should  not  touch  the  baby's  scalp 
during  the  early  months  and  strong  soap  and  friction 
must  be  avoided  in  the  removal  of  the  accumulations. 
Temperature  The  sensitiveness  of  infants  to  heat  and  cold  is 

not  surprising  when  we  consider  the  conditions, 
viz.,  the  relatively  large  radiating  surface  of  the 
body  (50  per  cent  more  than  the  adult),  the  thinness 
of  the  skin,  the  distensibility  of  its  blood  vessels,  and 
the  undeveloped  state  of  the  heat  regulating  centers. 
The  normal  body  heat  is  highest  in  the  afternoon 
and  the  lowest  from  12  to  4  a.  m.  Rectal  temper- 
ature, as  a  rule,  is  the  only  reliable  one,  as  in  the 
young  infant  the  mouth  can  not  be  utilized  for  that 
purpose,  and  the  surface  of  the  body,  for  reasons 
above  stated,  shows  a  temperature  two  or  three 
degrees  lower  than  that  of  the  blood. 

THE    BABY'S    CLOTHES 


Weight 

and 

Texture 


In  the  care  of  the  baby  uniformity  of  the  sur- 
rounding temperature  should  be  maintained  and  the 
child  protected  from  excessive  radiation  by  cloth- 
ing. Nothing  is  more  appropriate  for  this  purpose 
than  wool  and  as  lightness  is  desired  two  thick- 
nesses are  better  than  one  containing  the  same 
amount  of  material.  Simply  made  clothing  without 
elaborate  ornamentation  and  trimming  designed  for 
the  baby's  comfort  shows  better  taste  in  the  mother. 


BABY'S  CLOTHES  21 

The  clothing-  should  not  interfere  with  freedom  of       Freedom 

0  .  .  from 

muscular  movement  or  blood  circulation.     This  means       Restraint 
that  it  should  permit  unrestrained  freedom  of  move- 


BABY  CLOTHED  IN  A  SLEEVELESS  SACK  OR  "BABY  BAG." 

ment  of  all  the  muscular  structures,  whether  toes, 
fingers,  feet,  hands,  legs,  arms,  abdomen,  back  or  chest. 
The  evils  of  the  old  fashioned  pinning  blanket,  the 
tightly  drawn  diaper,  as  well  as  bands  about  the  chest 


Baby  Bag 


22  CARE  OF  CHILDREN 

and   abdomen,   and   any   tapes   or   strings    which    re- 
strict the  circulation  should  be  apparent. 

Since  the  object  of  clothing  for  the  infant  is  to  se- 
cure uniform  temperature  the  writer  can  conceive  of 
no  reason  why  one  portion  of  the  bod}'  requires  heavier 
clothing  than  another,  hence  material  of  uniform  thick- 
ness is  required  for  trunk  and  limbs. 


OUTER  AND  INNER  GARMENT  OF  THE  SLEEVELESS  SACK. 

Inner  garment  shown  closed  at  bottom  with  the  draw  string:  outer 
garment  opens.  Both  garments  are  fastened  at  the  neck  in  front 
with  safety  pins. 

The  The  ideal  protection  would  seem  to  be  afforded  by  a 
sack  of  light,  flexible,  nonconducting  material,  so  con- 
structed that  it  envelops  loosely  the  entire  body,  closed 


BABY'S  CLOTHES 


23 


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24 


CARE  OF  CHILDREN 


Night 
Garment 


Under 
Clothes 


above  by  safety  pins,  below  by  a  .draw  string.  Such  an 
arrangement  was  designed  by  the  author  and  has  been 
successfully  used  in  a  number  of  hospitals  in  this  coun- 
try and  abroad  as  well  as  in  private  homes.  There  is 
good  reason  for  including  the  hands  in  the  covering 
as  a  prevention  of  the  habit  of  putting  the  fingers  in 
the  mouth.  This  is  a  most  unhygienic  practice,  first 
because  it  favors  introduction  of  infections ;  second,  be- 
cause the  subsequent  chilling  of  the  parts  from  rapid 
evaporation  of  moisture  induces  local  congestions, 
causing  symptoms  of  indigestion,  colic,  etc.  The 
author  believes  that  the  hands  should  be  included  in 
the  outer  garment  for  the  first  five  or  six  weeks  of  life 
after  which  time  the  bag  may  be  replaced  by  the  usual 
white  nainsook  or  muslin  slip. 

The  bag  will  then  serve  as  an  ideal  night  garment 
for  the  first  six  months,  and  then  the  combination 
night  drawers  with  feet  are  recommended  because  with 
these  the  lower  extremities  cannot  be  entirely  un- 
covered. An  entire  change  of  clothing  should  always 
be  made  for  the  night. 

When  necessary  under  the  sack,  additional  protec- 
tion against  cold  is  afforded  by  separate  under  gar- 
ments, as  a  light  knitted  shirt  of  silk  and  wool  and  a 
sleeveless  slip  of  baby  flannel. 

The  best  under  garment  for  a  baby  is  the  knitted 
long  sleeved  shirt  of  mixed  lamb's  wool  and  silk.  This 
shrinks  less  and  is  less  apt  to  be  irritating  to  the  skin 
than  all  wool,  and  is  warmer  than  the  all  silk.  The 
same  material,  or  a  mixture  of  wool  and  cotton,  is  suit- 


BABY'S  CLOTHES  25 

able  for  the  stockings,  which  should  be  long  enough 
to  pin  to  the  diaper,  which  in  turn  is  pinned  to  the 
shirt,  thus  leaving  no  portion  of  the  child  uncovered. 
No  socks  or  bootees  are  needed.  Over  this  the  baby 
bag  as  described  furnishes  all  the  clothing  necessary 
for  moderately  warm  weather. 


A  KNITWEAR  INFANT  SHIRT. 

In  winter,  or  where  the  baby  cannot  be  protected  In 
from  drafts,  an  additional  garment  without  sleeves,  winter 
reaching  from  the  neck  to  ten  or  twelve  inches  below 
the  feet,  may  be  used  next  the  shirt.  Some  mothers 
prefer  to  close  this  garment  with  a  draw  string,  leav- 
ing the  outer  garment  open  and  long  enough  to  conceal 
the  draw  string  effect  of  the  skirt. 

Scotch  flannel  in  its  various  dainty  shades  and  pat-     Materiai 
terns  is  excellent  unshrinkable  material  for  the  bag, 
while  soft,  white  baby  flannel  is  suitable  for  the  inter- 
mediate garment.     No  other  clothing  is  necessary  for 


26 


CARE  OF  CHILDREN 


The 
Diaper 


the  first  few  weeks,  unless  a  light  shawl  or  quilt  for 
carrying  the  baby  from  room  to  room,  and  a  light  silk 
scarf  for  occasional  use  to  protect  the  head  from  pos- 
sible drafts. 


"  THE  FIRST  LAYER." 
Diaper  fastened  to  the  shirt,  and  stockings  with  safety  pins. 

The  diaper  should  be  light  with  no  more  material 
than  is  absolutely  necessary  for  the  absorption  of  the 
discharges.  Absorbent  cotton,  loose  or  in  pads,  pref- 
erably the  latter,  retained  by  a  loose  cheesecloth 
diaper,  which  is  secured  to  the  shirt  by  safety  pins  in 


BABY'S  CLOTHES 


27 


front  and  behind,  has  been  found  to  meet  all  require- 
ments. Where  economy  prohibits  the  use  of  absorbent 
cotton  (which  must  be  destroyed  when  soiled)  a  square 
of  folded  cheesecloth  which  can  be  washed  may  be 
substituted. 

No  mention  is  made  of  the  belly  band  for  the  reason 
that  in  the  writer's  opinion  none  is  needed  after  the 
dropping  of  the  cord  until  which  time  the  cord  dress- 
ing should  be  retained  by  a  bias  band  of  unhemmed 
flannel.  This  should  be  from  three  to  four  inched  wide 
and  about  twenty-four  inches  long.  Small  safety  pins 
may  be  used  for  fastening. 

In  dressing  the  child,  its  head  and  neck  should  al- 
ways be  supported  by  the  hand  or  arm  of  the  nurse. 
The  weight  of  the  young  infant  should  never  be  al- 
lowed upon  the  unsupported  spine  as  in  the  sitting 
posture,  until  five  months,  even  in  rugged  children,  and 
then  only  for  a  short  time.  Much  harm  results  from 
too  early  use  of  the  high  chair  and  modern  perambula- 
tor. 

SHORT   CLOTHES 

Since  all  clothing  limits  to  a  certain  extent  the  free- 
dom of  movement  so  essential  to  nutrition  and  growth, 
the  shortening  of  garments  is  obviou.Jy  a  gain  in  the 
child's  hygiene.  The  careful  mother  will  be  governed 
by  the  vigor  of  the  child  and  its  surroundings  as  well 
as  the  season  in  the  matter  of  shortening  its  clothes. 

The  first  short  clothes  need  differ  in  no  material  re- 
spect from  the  long  clothes  except  in  the  length  of  the 
skirts. 


No 

Belly 

Band 


Care  In 
Dressing 


Time 

Dependent 
on  Climate 


28 


CARE  OF  CHILDREN 


Waist 

and 

Drawers 


Foot 

Covering 


Moccasin 
Shoe 


When  diapers  are  no  longer  necessary  short  knitted 
drawers  are  substituted,  which,  with  the  stocking  sup- 
porters, are  attached  to  a  waist.  In  winter  the  waist 
should  be  of  flannel,  with  or  without  sleeves,  and  the 
drawers  of  wool  extending  to  the  ankle. 

The  shortening  of  the  skirts  necessitates  extra  pro- 
tection for  the  feet.  Before  the  creeping  time  the 
knitted  shoes  without  soles  should  be  used.  Later  the 
more  durable  kid  or  chamois  moccasins  are  neces- 
sary4^Unwittingly,  great  cruelty  is  practiced  in  the 
conventional  baby  foot  covering. 

Most  of  the  prevailing  deformities  seen  in  the  civ- 
ilized foot  have  their  origin  in  infancy  at  a  time  when 
the  rapid  growth  of  this  plastic  member  is  easily  re- 
tarded or  perverted  by  the  slightest  degree  of  persist- 
ent pressure,  as  from  a  too  short  or  too  narrow  stock- 
ing. Chalk  the  sole  of  the  baby's  foot  and  press  it 
against  a  damp  slate  or  hard  black  surface  and  com- 
pare the  impression  with  the  outline  of  the  ordinary 
baby  shoes  sold  in  the  shops. 

The  rapid  growth  necessitates  frequent  renewal  of 
the  moccasin  shoe,  which  should  be  made  for  the  feet, 
respectively,  rights  and  lefts.  They  should  fit  the  foot 
firmly  only  about  the  ankle  and  instep  leaving  ample 
room  for  the  elongation  and  spreading  of  the  toes.  To 
secure  proper  adjustment  shoes  should  be  laced  rather 
than  buttoned. 

In  learning  to  walk  all  the  separate  muscles  must  be 
educated  to  act  in  unison,  hence  every  part  of  the  foot 


BABY'S  CLOTHES  29 

and  its  toes  must  be  allowed  the  utmost  freedom.  A 
snug  shoe  deprives  some  of  these  muscles  of  their  op- 
portunity for  education  by  binding  the  parts  together 
to  act  as  a  unit  instead  of  in  unison.  A  stiff,  unyield- 
ing sole  interferes  with  the  foot  grasp  of  the  ground. 


SHAPE  OF  CHILD'S  FOOT  AND  PROPERLY  SHAPED  SHOE. 

As  well  might  the  child  be  taught  to  play  the  piano 
with  hands  encased  in  husking  gloves  as  to  attempt 
to  gain  perfect  control  of  locomotion  in  the  modern 
shoe.  Hard  shoe  soles,  like  ancient  sandals,  are  merely 
the  outgrowth  of  the  necessities  of  travel  and  have  no 
place  in  the  hygiene  of  infancy. 


30 


CARE  OF  CHILDREN. 


No 

Bands 


No 
Constrictions 


Since  vital  capacity  is  best  measured  by  lung  expan- 
sion anything  that  interferes  in  the  slightest  degree 
with  the  movements  of  the  ribs  or  diaphragm  limits 
by  so  much  vital  capacity.  A  tight  band  around  the 
abdomen  interferes  with  the  normal  muscular  move- 
ments of  the  stomach  and  bowels,  weakens  the  ab- 
dominal walls  and  is  frequently  the  cause  of  rupture 
both  at  the  navel  and  groin. 

A  constriction  around  the  hips,  as  from  a  tight 
diaper,  retards  the  growth  of  the  pelvis  at  a  time  when 
its  substance  is  mostly  cartilaginous  and  is  undoubt- 
edly one  of  the  causes  of  the  prolonged  travail  so 
common  to  American  mothers. 


Proper 
Protection 


CLOTHING   FOE  OLDER   CHILDREN 

As  the  child  grows  older  its  style  of  dressing  neces- 
sarily changes  but  certain  facts  must  still  be  borne  in 
mind.  In  the  adult  more  than  three-fourths  of  the  heat 
produced  in  the  body  is  given  off  from  the  surface  of 
the  skin.  In  children  the  per  cent  of  loss  is  probably 
still  greater  because  the  proportional  surface  of  the 
body  exposed  is  larger.  One  of  the  important  func- 
tions of  clothing  is  to  regulate  the  movement  of  air 
streaming  to  and  from  the  surface  of  the  skin  so  as 
to  retard  the  exchange  of  the  warm  air  surrounding 
the  body  with  the  outer  atmosphere  without  preventing 
it.  The  material,  form  and  cut  of  the  clothing  all  have 
to  do  with  the  proper  performance  of  this  function. 

All  vital  processes  require  a  certain  uniform  tern- 


CLOTHING  31 

perature  and  interference  with  these  is  especially  dis- 
astrous during  the  period  of  rapid  growth.  All  en- 
deavor is  made  to  maintain  this  for  the  infant,  but  it  is 
often  overlooked  for  the  child,  where  the  need  still  re- 
mains as  great. 

Clothing  may  become  the  cause  of  disease,  either  be-  Materials 
cause  of  permitting  sudden  chilling  of  the  body  or  be- 
cause of  checking  the  circulation,  respiration  or  per- 
spiration. The  material  should  be  selected  with  spe- 
cial consideration  for  the  constitution,  sex  and  age  of 
the  child ;  its  power  of  heat  regulation,  and  should  be 
suited  to  the  child's  skin  as  well  as  so  designed  that 
it  may  permit  liberty  of  movement. 

A  word  of  caution  should  be  given  against  the  Bare  Legs 
prevailing  fad  of  bare  legged  children.  The  bare 
footed  country  boy,  living  out  of  doors  all  the  time, 
clad  only  in  shirt  and  trousers,  may  resist  the  ex- 
posure ;  but  there  is  danger  to  the  otherwise  warmly 
clad  city  child.  When  the  stockings  are  left  off  and 
socks  and  low  shoes  substituted,  for  the  sake  of 
coolness  near  home,  the  custom  is  permissible ;  but 
in  our  fickle  climate,  when  a  change  of  weather  or 
a  thunder  storm  may  lower  the  temperature  from 
20  to  40  degrees,  there  is  grave  danger  of  a  chill. 
This  disturbs  the  circulation  and  may  induce  digest- 
ive disturbances,  colds,  or  serious  illness.  A  child's 
health  should  not  be  endangered  by  fad  or  fashion. 


SURROUNDINGS  AND  CARE 

Protection  The  absolute  wants  of  the  infant  are  few  and  simple, 
and  may  be  expressed  in  the  two  words — Protection 
and  Food. 

The  infant  must  be  protected  from  shock  to  which 
he  is  peculiarly  susceptible.  Normal  function,  as  di- 
gestion, may  be  arrested  by  shock  alone.  Shock  may 
occur  from  sudden  changes  of  temperature,  from  noise, 
from  blows  or  jars,  from  unaccustomed  motion,  from 
fear  or  anger,  from  intense  light,  and  from  excessive 
or  prolonged  pain. 

Protection  should  be  secured  from  infectious  or  ir- 
ritating substances,  either  internal  or  external.  The 
baby  should  not  be  subjected  to  rough  handling  or 
rough  clothing;  it  should  be  protected  from  liability  to 
falls,  or  from  blows  especially  on  the  head,  and  from 
wounds,  scratches,  bites  or  abrasions  of  any  kind.  Its 
surroundings  should  be  as  sanitary  and  antiseptic  as 
possible  in  all  particulars. 

THE   NURSERY 

The  multiplicity  of  these  needs,  not  to  mention  the 
necessity  of  regularity  in  feeding,  bathing,  sleeping 
and  so  forth  demands  a  systematic  regime.  Obviously 
this  can  best  be  seoured  through  a  separate  nursery 
in  which  the  means  to  the  end  are  under  full  control. 

The  room  selected  for  this  purpose  should  be  in  a 
quiet  part  of  the  house  and  should  receive  direct  sun- 
light during  as  much  of  the  day  as  possible.    It  should 

32' 


The 
Room 


THE  NURSERY 


33 


be  of  sufficient  size  to  secure  ventilation  without  notice- 
able drafts,  and  furnished  with  special  reference  to  an- 
tisepsis, hence  carpetless,  except  for  rugs  which  may 
be  aired  often ;  curtainless,  except  for  light  wash  ma- 
terials ;  devoid  of  moldings,  pictures  or  fixtures  which 
invite  the  lodgment  of  dust.  The  walls  should  be 
hard  finished,  preferably  painted  to  permit  of  thorough 
cleansing  with  water  or  antiseptic  applications.  Double 
windows  should  protect  against  drafts  and  diminish 
direct  radiation,  and  the  system  of  heating  and  ventila- 
tion be  under  absolute  control.  The  temperature 
should  be  from  75  °  to  8o°  F.  during  the  first  week  after 
which  time  until  the  child  is  three  months  old  about 
750  is  recommended.  After  that  it  may  be  gradually 
lowered  to  700  or  even  650  at  night.  If  the  sleeping 
room  be  too  hot  and  the  rarified  air  fails  to  furnish  the 
necessary  amount  of  oxygen  the  child's  vitality  is  low- 
ered by  copious  perspiration  and  his  susceptibility  to 
cold  taking  is  increased. 

The  nursery  should  preferably  not  be  upon  the 
ground  floor,  or  on  a  level  with  the  ground.  Plumbing 
of  any  kind,  even  the  best  stationary  washstand,  should 
find  no  place  in  this  room,  and  it  is  even  better  to  se- 
lect a  room  not  having  direct  connection  with  the  fam- 
ily bathroom,  as  being  more  free  from  possible  impure 
gases. 

In  fact  the  room  should  contain  nothing  save  the 
furniture  necessary  for  the  care  of  the  infant.  The 
metal  crib  should  have  a  mattress  filled  with  selected 


Furnishing: 


Temperature 


Furniture 


34 


CARE  OF  CHILDREN 


Simple 
Articles 


First 
Year 


hair,  and  if  any  pillow  is  used  it  should  be  a  very  thin 
one  of  the  same  material.  The  mattress  should  be  pro- 
tected by  a  thin  rubber  sheet  placed  under  a  quilted 
pad,  and  the  covering  should  be  of  light  wool. 

The  different  articles  necessary  in  a  nursery  should 
be  as  simple,  strong,  light  and  plain  as  possible.  Up- 
holstery is  not  desirable,  and  the  furni- 
ture for  the  child  should  be  suited  to 
it.  That  is,  the  tables,  chairs,  etc., 
that  it  is  to  use  should  fit  the  child 
not  the  older  person.  For  the  infant 
a  bath  tub  (flexible  rubber  preferred), 
a  bath  thermometer,  wall  thermom- 
eter, scales,  a  double  ewer,  soap  dish, 
on  a  low  table,  around  which  stand  a 
high  folding  screen,  are  requirements. 

SLEEP 

A  very  young  baby  should  sleep 
about  twenty  hours  out  of  the  twenty- 
four,  in  fact  all  the  time  when  not 
being  nursed,  bathed  or  changed.  Xo 
definite  statement  can  be  made  as  to 
the  exact  number  of  hours  that  a  babe  should  sleep  at 
a  given  age.  No  error  will  be  made  if  the  child  is 
encouraged  to  sleep  all  that  he  will  during  the  first 
year,  being  guarded  against  all  noise  and  disturbances. 
Rocking  and  carrying  are  advised  against  as  unneces- 
sary and  possibly  harmful.  Certainly  the  jumping  up 
and  down  of  a  tiny  infant  in  the  mistaken  belief  that 


Weighing  the 
Baby. 


SLEEP 


35 


its  comfort  is  thus  increased  is  ridiculous  and  not 
conducive  to  the  best  good  of  the  baby. 

The  sleep  during  the  first  few  days  is  profound,  but 
during  the  rest  of  the  year  it  is  easily  disturbed.  The 
position  of  the  child  should  be  changed  during  the 
longest  sleep  of  the  night.  During  the  time  when  the 
bones  of  the  head  are  hardening  it  is  necessary  to 
change  the  position  of  the  baby,  putting  it  first  on  one 
side,  then  on  the  other,  that  its  head  may  not  exhibit  a 
flattening  on  one  side. 

It  is  important  to  preserve  great  regularity  in  the 
hours  of  sleeping.  No  child  under  six  years  can 
afford  to  forego  the  daily  nap,  for  which  the  shoes 
and  outer  clothing  at  least  should  be  removed. 

A  normal  healthy  baby  with  wants  satisfied  will  sleep 
if  comfortable  and  left  alone.  The  fussy  nurse  or 
mother  too  frequently  interferes  with  this  function 
by  over  solicitude  or  mistaken  notion  that  the  baby 
wants  companionship.  It  is  better  to  put  it  in  its 
crib  and  if  possible  go  into  an  adjoining  room,  to 
accustom  the  child  from  the  very  beginning  to  sleep- 
ing alone.  A  few  experiences  will  establish  the 
habit  and  thus  save  the  mother  much  time  and 
strength  as  well  as  give  the  child  better  and  more 
regular  sleep.  If  the  habit  is  fixed  early  no  difficulty 
will  be  experienced. 

The  custom  of  quieting  the  baby  by  the  use  of  a 
blank  nipple — "soother" — is  not  only  extremely  un- 
sanitary, but  is  positively  injurious.  No  more  effi- 
cient means  for  introducing  the  ever  present  disease 


Regularity 


The 
Soother 


36 


CARE  OF  CHILDREN 


Thumb 
Sucking 


Vicious 
Circle 


germs  into  the  system  could  be  devised  and  many  a 
mysterious  infection  may  be  explained  by  this 
practice. 

The  habit  of  thumbsucking,  if  long  continued,  very 
commonly  induces  changes  in  the  shape  of  the  mouth, 
teeth  and  jaws  which  amount  in  some  cases  to  a  de- 
formity. 

It  is  sometimes  difficult  to  secure  the  necessary 
amount  of  sleep  for  children  of  active  mentality  or 
nervous  temperament.     Insufficient  rest  increases  this 


DEFORMITIES  CAUSED  BY  PROLONGED  THUMB 
SUCKING.     (Talbot.) 


Disturbed 
Sleep 


natural  nervousness,  which  in  turn,  tends  to  prevent 
sleep,  thus  establishing  a  "vicious  circle"  which  robs 
growth,  arrests  development  and  finally  destroys  the 
child  or  wrecks  his  future  life. 

The  causes  of  disturbed  sleep  are  so  numerous  and 
intricate  that  a  brief  enumeration  of  those  most  ap- 
parent must  suffice. 


EXERCISE  37 

Besides  the  physical  discomforts  due  to  bed  or  cloth- 
ing, insect  bites,  soiled  diapers,  constipation,  skin  irri- 
tations, excess  of  heat  or  cold,  the  child  may  suffer 
pain  arising  from  internal  conditions,  such  as  earache, 
headache,  intestinal  disturbance,  kidney  colic,  rheuma- 
tism (growing  pains),  sore  mouth,  or  feverish  condi- 
tions from  various  infections  to  which  he  is  especially 
subject.  Sleep  disturbance  is  frequently  due  to  inter- 
ference with  respiration  from  catarrh  of  the  nose  or 
adenoid  growths  in  the  naso-pharynx  or  enlarged  ton- 
sils. Here,  also,  may  be  mentioned  worms,  intestinal 
or  rectal,  and  disorders  of  the  genitals. 

The  most  common  cause  of  restlessness,  however,  is 
indigestion  due  to  improper  food  or  methods  of  feed- 
ing. 

EXERCISE 

Exercise  is  absolutely  essential  to  the  normal  growth  crying, 
and  development  of  all  the  muscular  structures.  Lusty  f£;kinB' 
crying,  if  not  prolonged,  has  a  beneficial  effect  in  the 
deeper  respiration  thereby  induced.  So  stretching, 
kicking,  squirming  and  waving  of  arms  secure  in  a 
measure  the  needed  exercise.  Occasional  massage  is 
advised,  the  infant's  expression  of  pleasure  being  one 
of  the  immediate  evidences  of  its  beneficial  effects. 
After  the  creeping  age  the  infant  usually  secures 
enough  muscular  exercise.  The  creeping  pen,  raised 
a  few  inches  above  the  floor,  is  recommended  for  clean- 
liness and  protection  against  floor  drafts. 

It  is  essential  that  the  baby  have  frequent  change  of      Daily 
air.    Direct  sunlight  is  needed,  but  it  is  advisable  be- 


38 


CARE  OF  CHILDREN 


Temperature 


Bran  and 
Salt  Bath 


fore  taking  the  baby  out  of  doors,  that  he  be  gradually 
accustomed  to  the  outside  air  by  opening  the  windows 
of  the  nursery  for  a  short  period  each  day,  keeping  in 
mind  the  need  of  additional  clothing  in  cold  weather. 

As  a  rule,  the  child  should  go  out  daily  after  the  first 
month.  The  more  weakly  the  child  the  greater  the 
need.  One  caution  should  always  be  observed  in  his 
outing,  protection  from  disturbance  in  securing  his  re- 
quisite amount  of  sleep.  In  fact,  he  may  spend  the 
greater  part  of  the  day  in  the  open  air,  if  properly  pro- 
tected from  wind  and  sun. 

BATHING 

After  the  first  week,  the  strong,  healthy  baby  should 
be  bathed  daily.  The  temperature  of  the  first  baths 
should  be  about  blood  heat,  99°  F.  This  may  be  re- 
duced gradually  so  that  at  the  end  of  the  month  the 
temperature  will  be  95°,  at  six  months  90°  and 
by  the  end  of  the  year  850  to  8o°.  It  is  well  to  finish 
bathing  and  drying  the  head  before  undressing  the 
baby.  Little  soap  is  required  and  if  the  skin  is  unusu- 
ally delicate,  that  known  as  "superfatty"  is  advised. 
The  convenience  of  the  double  ewer  is  seen  in  having 
a  supply  of  water  free  from  soap  for  rinsing.  Unless 
some  irritation  is  present  no  powder  need  be  used. 
The  addition  of  the  bran  bag  to  the  bath  for  children 
with  a  tendency  to  eczema,  and  of  salt  for  its  stimulat- 
ing properties  to  the  infants  needing  it,  is  recom- 
mended. The  daily  bath  should  be  given  midway  be- 
tween feedings  and  should  not  last  longer  than  five 


BATHING 


39 


minutes.  The  toweling,  though  thorough,  must  be 
lightly  and  quickly  done. 

The  special  care  of  the  eyes,  nostrils  and  mouth 
must  never  be  omitted.  As  soon  as  the  temporary 
teeth  have  appeared,  they  should  receive  as  faithful  at- 
tention as  the  permanent,  since  they  are  as  subject  to 
decay,  and  effects  of  digestive  disturbances  are  greater 
in  the  child.  Nothing  should  ever  be  introduced  into 
the  external  ear  with  the  exception  of  a  twisted  bit  of 
gauze,  gently  applied  for  the  purpose  of  drying. 

Not  only  are  the  genitals  subject  to  local  disorders 
but  general  mal-nutrition,  obstinate  reflex  nervous  dis- 
turbances and  injurious  habits  are  too  often  the  result 
of  their  neglect.  The  daily  bath  should  ensure 
thorough  gentle  cleansing  of  the  delicate  parts,  which 
with  the  boy  baby,  should  include  the  complete  retrac- 
tion of  the  foreskin.  If  this  is  not  accomplished  by 
the  end  of  the  first  month  the  physician  should  be  con- 
sulted. 

In  hot  weather  a  rapid  sponging  with  tepid  water  at 
night  will  secure  for  the  baby  a  more  restful  sleep. 

The  duration,  as  well  as  the  frequency  of  the  bath, 
should  depend  entirely  upon  the  reaction ;  blueness  or 
chilliness  of  the  surface,  or  signs  of  exhaustion  are 
always  indications  of  too  frequent  or  too  prolonged 
bathing. 

BEGTJXATION 

The  structure  of  the  rectum  and  lower  bowel  in  in- 
fancy, with  the  weakness  of  the  abdominal  walls,  makes 


Special 
Care 


Duration 

and 

Frequency 


4o  CARE  OF  CHILDREN 

extrusion  of  firm  feces  somewhat  difficult.  In  the  care 
of  the  infant  no  day  should  be  allowed  to  pass  with- 
out at  least  one  free  bowel  movement.  The  establish- 
ment of  the  habit  of  regular  defecation  is  possible  at 
a  surprisingly  early  age.  The  regular  practice  of  hold- 
ing the  baby  over  the  chamber  before  an  evacuation 
will  soon,  by  association,  lead  to  defecation  when 
placed  in  that  position.  If  this  practice  is  followed  by 
the  end  of  a  few  months  the  nursery  chair  may  replace 
the  diaper. 
Constipation  *n  obstinate  constipation  the  daily  movement  may  be 

secured  only  by  the  judicious  use  of  the  soap  or  glycer- 
ine suppository,  or  preferably,  a  small  soap  and  water 
enema  administered  with  the  baby  lying  on  his  stomach 
across  the  lap.  A  copious  injection  is  best  given  with 
the  baby  lying  on  his  left  side. 

In  older  children  the  rectum  is  usually  empty.  When 
the  fecal  mass  descends  into  the  rectum  the  uneasy 
sensations  are  produced  which  precede  a  normal 
evacuation.  If  this  call  is  neglected  the  action  of  the 
rectum  is  reversed  and  the  fecal  matter  is  forced  back 
again  into  the  less  sensitive  portion  of  the  large  intes- 
tine where  it  may  remain  and  harden  by  the  absorption 
of  its  fluid  constituents.  By  frequent  repetition  even 
the  rectum  loses  its  sensitiveness  so  that  large  accumu- 
lations of  fecal  matter  may  occur  without  exciting 
evacuative  desire.  The  calls  of  nature  must  be  re- 
garded as  imperative.  Their  neglect  may  be  the  be- 
ginning of  grave  and  irremediable  conditions,  such  as 


REGULATION 


41 


permanent  distension  of  the  lower  bowel  with  loss  of 
evacuative  power. 


GIVING  AN  ENEMA. 

The  lower  end  of  the  rubber  sheet  Is  placed  In  a  pail.    The  bag  of  the 
fountain  syringe  should  not  be  hung  too  high. 


DEVELOPMENT  AND  GROWTH 
importance  The  importance  of  a  familiarity  with  the  rate  of 

growth  during  infancy  and  childhood  can  not  be  over 
estimated,  as  the  irregularities  in  the  growth  ratio  are 
frequently  the  first  intimations  of  disturbed  nutrition 
or  developing  disease. 

The  following  table  shows  the  average  heights  and 
weights  from  birth  to  fourteen  years: 

Table  of  Height  and  Weight 


Boys. 

Age. 

Girls. 

Height. 

Weight. 

Height. 

Weight. 

Inches. 

Pounds. 

Inches. 

Pounds. 

19.75 

7.15 

Birth. 

19  25 

6  93 

24.75 

14.30 

5  months. 

23.25 

13.86 

29.53 

20.98 

1  year. 

29.67 

19.80 

33.83 

30.36 

2  years. 

32.94 

29.28 

37.06 

34.98 

3  years. 

36.31 

33.15 

39.31 

37.99 

4  years. 

38.80 

36  36 

41.57 

41.00 

5  years. 

41.29 

39.57 

43.75 

45.07 

6  years. 

43.35 

43.18 

45.74 

48.97 

7  years. 

45.52 

47  30 

47.76 

53.81 

8  years. 

47.58 

51.56 

49.69 

59.00 

9  years. 

49.37 

57.00 

51.68 

65.16 

10  years. 

51.34 

62.23 

53.33 

70.04 

11  years. 

53.42 

68.70 

55.11 

76.75 

12  years. 

55.88 

78.16 

57.21 

84.67 

13  years. 

58.16 

88.46. 

59.88 

94.49 

14  years. 

59.94 

98.23 

Increase  in  body  weight,  length  and  the  measure- 
ments of  the  different  members  bear  normally  a  cer- 
tain constant  relation  at  different  periods  of  life.  No 
period  compares  in  rapidity  of  growth  with  that  of  the 

first  three  months. 

42 


DEVELOPMENT  AND  GROWTH 


43 


The  loss  of  weight  in  the  first  three  days  is  about 
ten  per  cent.  This  is  usually  regained  by  the  end  of 
the  first  week.  The  reason  for  this  early  loss  is  due 
partly  to  the  loss  of  fluids  from  the  interior  as  well  as 
from  the  surface  of  the  body,  and  partly  to  the  con- 
Daily  Weight  Chart    (Holt) 


First 
Loss  in 
Weight 


Lbs. 

1 

2 

8 

i 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

^C 

17 

18 

19 

20 

9 

&x 
$x 

8 

7Ji 

7 

6* 

6K 

«M 
6 

5* 
5K 

5>4 

\ 

sumption  of  the  stored  body  material  before  the  first 
feeding  takes  place. 

The  loss  of  weight  is  several  ounces  but  at  the  end 
of  the  first  week  the  baby  has  usually  regained  most 


Rate  of 

Increase 


44 


CARE  OF  CHILDREN. 


of  the  loss.  After  this  the  gain  should  be  steady.  Dur- 
ing the  last  three  weeks  of  the  first  month  and  the  en- 
tire second,  this  gain  is  about  an  ounce  a  day.  During 
the  third  and  fourth  month's  about  three-fourths  of  an 

Monthly  Weight  Chart     (Holt) 


J 

MONTH  OF  AGE. 

123456          78          9        10        11      12 

21 
23 
22 
21 
■ 
13 
IS 
If 
16 
IS 
14 
13 
12 
11 
ID 
» 
8 
7 
0 
5 

Gain  in 
Length 


ounce  a  day,  hence  the  normal  infant  has  doubled  its 
birth  weight  by  the  end  of  the  fifth  or  sixth  month. 
The  gain  decreases  after  this  from  two-thirds  of  an 
ounce  to  one-half  an  ounce  a  day  as  the  infant  grows 
older,  until  the  weight  has  trebled  at  the  end  of  the 
first  year. 

The  length  of  the  average  baby  at  birth  is  nineteen 
inches ;  this  he  doubles  in  four  years.     The  increase 


Relative 


DEVELOPMENT  AND  GROWTH.  45 

during  the  first  year  (about  half  of  the  initial  length) 
being  nearly  double  that  of  any  succeeding  year.  The 
average  increase  of  the  second  year  is  about  four 
inches,  and  from  that  time  on  to  the  age  of  eleven  or 
twelve  years  from  two  to  three  inches  annually. 

As  the  weight  and  height  increase  there  is  also  a  rel- 
ative value  of  dimension  of  the  various  parts  of  the  Growth 
body.  The  legs  grow  much  more  rapidly  than  the 
trunk  but  the  girth  of  head  and  chest  are  of  the  great- 
est moment  in  determining  the  normal  growth.  The 
circumference  of  the  chest,  though  smaller  at  birth, 
should  exceed  that  of  the  head  before  the  end  of  the 
second  year. 

On  account  of  its  compressibility  the  shape  of  the 
chest  depends  largely  upon  the  continous  action  of  the  Che8t 
muscles,  hence  the  deformities  so  frequently  seen  as 
the  result  of  retarded  bone  development.  Any  pro- 
longed pressure  from  improper  position  or  constrict- 
ing clothing  may  add  greatly  to  chest  deformity. 

The  increase  in  the  circumference  of  the  head  in 
early  life  is  remarkable  and  like  that  of  the  body  weight 
is  more  rapid  during  the  first  year,  increasing  three 
inches  during  the  first  six  months,  a  little  more  than 
one  inch  the  second  six  months,  three-fourths  of  an 
inch  the  second  year  and  less  than  half  an  inch  the 
third  year.  By  the  seventh  year  the  head  has  attained 
nearly  its  full  size. 

The   fontanel   diminishes   in   size  towards  the   end 


The 


The 
Head 


46 


CARE  OF  CHILDREN 


Development 
of  Powers 


Capacity  of 
the  Stomach 


of  the  first  year  and  is  ordinarily  completely  closed 
before  the  end  of  the  second  year. 

This  period  of  growth  also  shows  a  constant  de- 
velopment of  acquisitions.  The  ability  to  shed  tears 
generally  comes  at  the  age  of  three  or  four  months. 
The  new  hair  has  begun  to  grow  and  increased  pow- 
ers of  digestion  are  developed.  This  is  the  time  when 
the  child  begins  to  "drool,"  a  sign  not  of  irritation 
caused  by  the  cutting  of  teeth  but  merely  an  evidence 
of  the  increased  flow  of  saliva  due  to  development  of 
digestive  secretions. 

The  characteristic  coating  of  the  baby  tongue  per- 
sists during  the  greater  part  of  the  nursing  period. 
The  roof  of  the  mouth  gradually  becomes  more  arched 
with  the  development  of  the  gums  and  teeth.  The 
soft  palate  becomes  ampler  as  it  descends  to  its  more 
verticle  position,  and  the  tonsils  increase  in  size. 

The  growth  of  the  stomach  is  most  rapid  in  the 
first  half  of  the  first  year,  of  which  the  first  three 
months  exhibit  by  far  the  greater  rate  of  increase. 
It  maintains  a  very  constant  ratio  of  increase  with 
that  of  body  weight  in  the  first  year  of  life. 

The  following  table  represents  fairly  the  average 
capacity  of  the  stomach  at  different  ages: 


At  birth 

End  of    1st  month   - 
End  of    2nd  month 
End  of    3rd  month  - 
End  of    4th  month 
End  of    Sth  month  - 
End  of  12th  month 


1      ounce. 

-  2yz  ounces. 
2>y2  ounces. 

-  4^  ounces. 
A%  ounces. 

-  5      ounces. 
8      ounces. 


TEETHING 


47 


TEETHING 


The  development  of  the  temporary  teeth  begins  with 
the  first  formation  of  the  jaws,  about  the  sixth  week 
of  intra-uterine  life.  At  the  time  of  birth  the  crowns 
of  all  the  temporary  incisors  and  canines  are  fairly 
advanced  in  calcification. 

The  gums  at  first  are  smooth  and  firm  and  of 
a  light  pinkish  color.  The  edges  are  rather  sharp 
but  grow  broader  after  a  few  months,  as  the  time 
of  teething  draws  near. 

Of  the  temporary  or  milk  teeth  as  they  are  called 
there  are  twenty,  ten  in  each  jaw ;  two  central  incisors, 
two  lateral  incisors,  two  canines  and  four  molars.  The 
lower  canines  are  called  the  stomach  teeth. 

The  teeth  have  a  certain  order  of  eruption,  but 
variation  is  not  uncommon.  It  is  not  a  contin- 
uous process,  but  occurs  in  groups,  with  intervals 
of  repose  between  successive  groups.  The  lower  cen- 
tral incisors  appear  from  the  sixth  to  the  ninth  month, 
their  coming  being  completed  in  about  ten  days ;  then 
follows  a  resting  period  of  two  or  three  months,  after 
which  the  upper  incisors  appear,  both  central  and  lat- 
eral. After  an  interval  of  a  few  months  come  the 
lower  lateral  incisors  and  first  molars,  four  or  five 
months  later  the  canines  and  finally,  about  the  second 
year,  the  second  molars. 


Milk 
Teeth 


Order  o" 
Eruption 


48 


Permanent 
Teeth 


Teething 
Falacies 


CARE  OF  CHILDREN 
Order  of  the  Eruption   of  the   Temporary   Teeth 


Lower  central  incisors 

Upper  incisors 

Lower  lateral  incisors  and 

first  molars      - 
Canines  » 
Second  molars    - 


6th  to  9th  month. 
8th  to  10th  month. 

15th  to  21st  month. 
16th  to  20th  month. 
20th  to  30th  month. 


Scarcely  a  year  elapses  after  complete  eruption  of 
the  milk  teeth  before  absorption  begins  at  the  root  and 
advances  towards  the  crown  which  either  falls  off  or 
is  pushed  out  by  the  growth  of  the  permanent  tooth 
below. 

The  permanent  teeth,  of  which  there  are  32,  may 
be  divided  into  two  sets,  the  ten  anterior  which  suc- 
ceed the  milk  teeth  and  six  others  that  are  added 
farther  back  in  the  jaw.  During  the  growth  of  the 
teeth  the  jaw  increases  in  depth  and  length  and  under- 
goes changes  in  form. 

Order   of   Eruption   of   Permanent   Teeth 


First  molars 
Central  incisors    ■ 
Lateral  incisors 
First  bicuspids 
Second  bicuspids 
Canines 
Second  molars  - 


6th  year. 

-     7th  year. 

8th  year. 

10th  year. 

11th  year. 

12th  to  13th  year. 

12th  to  15th  year. 


Third  molars  (wisdom  teeth)  17th  to  25th  year. 
The  lower  teeth  usually  precede  the  upper. 

The  prevalent  notion  that  the  eruption  of  the  teeth 
is  responsible  for  many  of  the  disorders  of  infancy 
is  not  only  fallacious  but  is  productive  of  considerable 


TEETHING 


49 


harm.  The  terms  "teething  fits,"  "teething  diarrhoea," 
"teething  fever,"  etc.,  have  no  foundation  in  fact. 
Many  infants  have  been  lost  for  want  of  professional 
aid  because  of  a  mistaken  notion  that  the  acute  dis- 
order was  a  necessary  accompaniment  of  teething. 
Occasionally,  however,  the  gum  over  the  advancing 


Incisora.r  -  - 


Permanent  Teeth 


Milk  Teeth 


DIAGRAM  SHOWING  USUAL.  ORDER  OF  ERUPTION  OF  THE 

TEETH,  UPPER  FIGURES  REPRESENTING  THE  UPPER 

JAW,  LOWER  FIGURES  THE  LOWER  JAW. 


tooth  shows  some  swelling  and  the  finger  biting  and 
the  general  peevishness  of  the  child  finds  relief  with 
the  appearance  of  the  tooth.  As  a  rule,  the  so-called 
symptoms  of  teething  are  the  appearance  of  teeth. 

The  fact  that  the  teeth  make  their  appearance  at  a 
time  when  the  transitional  condition  of  infant  develop- 


Confusi*. 

of  Idea* 


50 


CARE  OF  CHILDREN 


Retarded 
Teething 


ment  predisposes  to  a  variety  of  disorders  has  led  to  a 
confusion  of  ideas.  The  universal  dread  of  the  "second 
summer"  (teething  summer)  is  the  outgrowth  of  the 
frequency  of  digestive  disturbances  at  this  time  to 
which  the  eruption  of  the  teeth  bear  little  or  no  causa- 
tive relationship.  ^ 

No  tooth  eruption  is  ever  retarded  by  the  toughness 
of  the  gum.  Its  advance  may  be  arrested  by  a  tem- 
porary cessation  in  its  growth  due  to  nutritional  dis- 
turbances, which  of  themselves  produce  the  symptoms 
frequently  ascribed  to  the  slow  coming  tooth. 


Motor 
Development 


Taste 
and 

Touch 


DEVELOPMENT     OF     SPECIAL    SENSES 

Schiller's  observations  on  the  motor  nerves  of  the 
eye  show  the  perfection  not  only  of  its  mechanism, 
but  also  of  its  function,  at  an  early  period  of  infancy. 
This  illustrates  the  method  of  growth  in  so  much  that 
this  mechanism  furnishes  one  of  the  channels  of  in- 
formation before  the  higher  centers  are  capable  of 
utilizing  it,  the  process  being  an  educational  one. 

As  the  power  and  control  of  motion  increases  there 
is  a  development  of  senses  which  are  the  pathways  to 
the  mind.  The  nervous  system  of  the  infant  shows 
well  developed  sensory  and  motor  tracts,  but  the  con- 
trol power  of  the  higher  centers  is  tardier  in  its 
growth. 

Taste  and  touch,  especially  of  the  lips  and  tongue, 
are  fortunately  the  first  of  the  special  senses  to  show 


Vision 


DEVELOPMENT  OF  SPECIAL  SENSES  51 

activity,  as  these  are  necessary  in  the  instinctive  efforts 
of  the  young  to  obtain  sustenance. 

Hearing,  although  demonstrated  as  present  in  the      Hearing 
first  twenty-four  hours,  is  not  developed  sufficiently  to 
differentiate  between   sounds   before  the   end  of  the 
third  month. 

Contemporary  with  the  function  of  hearing  is  that 
of  vision.  Although  sensitiveness  to  light  and  blinking 
on  the  near  approach  of  objects  has  been  observed 
from  the  first  weeks,  still  it  is  not  until  the  end  of  the 
second  month  that  the  infant  may  recognize  his  mother 
by  sight. 

At  first  the  infant's  movements  are  automatic  or 
instinctive,  the  voluntary  muscles  showing  only  the 
purposeless,  irregular,  and  unsymmetrical  movements 
suggestive  of  the  mere  continuance  of  the  intra-uterine 
existence.  Co-ordinate,  voluntary  movements  are  first 
seen  in  the  face  and  upper  extremities,  the  hands  in 
addition  to  grasping  showing  prehensile  tendencies  by 
the  end  of  the  third  month.  Objects  are  carried  to  the 
mouth  at  about  this  time.  The  many  ineffectual  at- 
tempts to  locate  the  mouth  indicate  the  vast  amount  of 
energy  necessary  to  develop  co-ordination.  Although 
the  apparatus  including  muscles  and  nerves  is  fairly 
complete,  it  requires  multiple  repetitions  of  sensations, 
impressions,  volitions,  and  efforts  at  volition,  before 
the  establishment  of  such  co-ordination  as  will  ensure 
the  performance  of  the  most  simple  voluntary  motion. 


52 


CARE  OF  tHILDREN 


Expression 
of  Emotion 


Sitting 


Standing 


Walking 


About  the  end  of  the  third  month  the  voice  is  recog- 
nized as  expressing  emotions  such  as  anger,  fear  or 
pleasure.  About  this  time  tears  are  observed  to  accom- 
pany the  crying.  It  is  interesting  to  note  that  perspira- 
tion is  not  common  before  the  end  of  the  third  month. 

Following  the  development  of  the  senses  of  sight 
and  hearing  to  the  extent  of  differentiating  as  to  the 
color  and  size  of  subjects  and  the  quality  and  direction 
of  sound,  we  find  co-operation  of  the  muscles  of  the 
neck  to  a  degree  that  the  infant's  head  is  held  erect, 
balanced  and  turned  at  will. 

After  the  eighth  month  the  infant  should  be  able  to 
sit  for  a  short  time  without  support  and  shortly  after 
he  begins  to  creep,  roll  or  hitch  towards  desired  ob- 
jects. About  the  tenth  month  he  usually  utters  a  few 
indefinite  syllables,  singly  or  repeated,  as  da  da,  ma 
ma,  goo,  etc. 

Between  the  tenth  and  twelfth  months  he  shows  a 
disposition  to  pull  himself  up  on  his  feet,  is  usually 
able  to  stand  by  a  chair  and,  exceptionally,  may  walk 
alone  at  the  end  of  the  first  year. 

Infants  exhibit  a  marked  variation  as  to  the  time 
of  these  acquirements,  dependent  largely  upon  mus- 
cular vigor  and  education.  A  child  left  much  alone 
will  learn  to  develop  his  resources  earlier.  On  the 
other  hand,  he  will  talk  earlier  if  associated  with  other 
children. 

The  subject  of  infant  hygiene  should  not  be  dis- 
missed without  reference  to  a  practice  that  is  as  per- 


DEVELOPMENT  AND  GROWTH  53 

nicious  as  it  is  common,  viz.,  the  custom  of  regarding 
the  baby  as  a  plaything,  an  animated  toy  for  the  enter-  "»* a 
tainment  of  the  family  as  well  as  a  large  circle  of 
admiring  friends.  Children  are  fond  of  babies  and 
never  tire  of  stimulating  their  funny  performances. 
The  same  is,  unfortunately,  true  of  parents  and  friends, 
but  from  a  purely  economic  point  of  view,  such  amuse- 
ment is  exceedingly  expensive,  and  the  mortality 
statistics  are  constantly  increased  for  the  amusement 
of  the  elders.  Nervous  and  mental  wrecks  too  fre- 
quently owe  the  origin  of  their  disorders  to  want  of 
repose  in  early  infancy,  due  to  injudicious  stimulation. 
In  this  connection  let  it  be  understood  that  all  evi- 
dences of  mental  precocity,  called  "smartness,"  should 
be  regarded  as  danger  signals  and  call  for  repression, 
rather  than  encouragement.  Axiom — An  infant  dur- 
ing the  first  year  should  neither  be  amusing  nor 
amused. 


TEST  QUESTIONS 

The  following  questions  constitute  the  "written  reci- 
tation" which  the  regular  members  of  the  A.  S.  H.  E. 
answer  in  writing  and  send  in  for  the  correction  and 
comment  of  the  instructor.  They  are  intended  to 
emphasize  and  fix  in  the  memory  the  most  important 
points  in  the  lesson. 


CARE  OF  CHILDREN 


Read  Carefully.  Place  your  name  and  address  on  the 
first  sheet  of  the  test.  Use  a  light  grade  of  paper  and  write 
Qn  one  side  of  the  sheet  only.  Leave  space  between  the 
answers  for  the  notes  of  the  instructor.  Use  your  own 
words  and  answer  fully.  Read  the  lesson  paper  a  uumber 
of  times  before  attempting  to  answer  the  questions. 


1.  What  special   precautions   should  the  expectant 

mother  take? 

2.  What  are  fontanelles  and  why  should  they  be 

guarded  ? 

3.  What  can  you  say  of  the  bony  development  of  a 

young  baby  ? 

4.  Give  a  brief  outline  of  the  first  three  days'  care 

of  the  new  born  babe? 

5.  How  would  you  sterilize  gauze?     Why  is  this 

necessary  ? 

6.  Why  is  the  baby  so  susceptible  to  temperature 

changes  ? 

7.  In  clothing  an  infant  what  principles  are  to  be 

observed? 

8.  Describe  the  clothing  suitable  for  baby's  first  six 

weeks. 

9.  What  may  be  the  effects  of  tight  clothing  about 

the  chest?    Abdomen?    Hips? 

10.  How  should  a  baby  be  put  to  sleep  ? 

11.  Name   some  of   the   commonest  causes   of   dis- 

turbed sleep. 


CARE  OF  CHILDREN 

12.  What  objections  are  there  to  the  "soother"? 

13.  Give  your  ideas  of  a  nursery. 

14.  What  can  you  say  of  the  effects  of  teething  upon 

the  infant's  health? 

15.  During  what  period  is  growth  most  rapid? 

16.  Why  is  familiarity  with  the  rate  of  growth  im- 

portant ? 

17.  Name  the   milk  teeth   and   give  their  order  of 

eruption. 

18.  Why  should  the  temporary  teeth  be  cared  for  and 

how  ? 

19.  How  do  you  interpret  the  statement  "The  senses 

are  the  pathways  to  the  mind"  ? 

20.  What  objections  are  there  to  playing  unduly  with 

with  the  baby? 

21.  Is  any  point  not  clear  or  are  there  any  questions? 

Note. — After  completing  the  test  sign  your  full  name. 


CARE  OF  CHILDREN 

PART  II 


NATURE S  METHOD. 

'The  act  of  nursing  in  its  perfection  is  the  result  of  the  mutual  co- 
operation of  mother  and  child." 


CARE  OF  CHILDREN 

PART  II 

Nutrition  of  the  Child 


The  subject  of  nutrition  will  always  be  of  para- 
mount importance  in  the  care  of  infants  and  children. 
As  important  as  food  is  to  supply  energy  for  the  mani- 
fold functions  of  adult  life,  it  is  doubly  important 
during  infancy,  as  during  this  period  the  demands 
for  material  for  growth  are  most  imperative.  Since, 
therefore,  the  necessity  for  food  is  a  double  one  dur- 
ing the  developing  period  the  importance  of  a  thor- 
ough knowledge  of  all  that  pertains  to  foods  and 
feeding  cannot  be  exaggerated. 

Errors  in  diet,  especially  in  infancy,  are  respon- 
sible for  more  deaths  and  cases  of  imperfect  develop- 
ment than  all  other  causes  combined.  In  fact,  the 
highest  degree  of  infant  mortality,  especially  during 
the  summer  months,  is  admittedly  due  to  mismanage- 
ment of  the  feeding.  For  this  reason  infants  nursed 
at  the  breast  are  fortunate,  as  they  escape  many  of 
the  dangers  to  which  artificially-fed  infants  are  sub- 
jected. 

Children,  as  well  as  infants,  require  the  best  of 
nutrition,  not  only  to  meet  the  demands  for  material 
for  growth,  but  also  to  furnish  energy  for  the  enor- 
mous work  of  training  and  educating  the  muscles,  as 
well  as  for  the  development  of  the  mind.  The  school 
pupil  is  a  machine  which  not  only  converts  raw  mate- 

55 


Importance 


Diet  and 

Infant 

Mortality 


Requirements 
of  the 
Child 


56 


CARE  OF  CHILDREN 


Nature's 
Supply 


Early 

Nursing 
Advisable 


rial  (food)  into  ideas,  but  also  utilizes  the  food  to 
construct  the  machine  itself.  What  wonder,  then, 
that  many  failures  in  the  educational  scheme  must  be 
attributed  to  the  improper  food  supply.  Because  of 
imperfect  nutrition,  the  imperfect  machine  not  only 
furnishes  unsatisfactory  products,  but  is  liable  to  mis- 
hap from  its  inherent  weakness,  as  in  the  case  of 
children  who  fall  an  easy  prey  to  the  various  in- 
fections against  which  a  well-nourished  constitution 
would  have  proved  a  safeguard. 

NATURAL   FOOD 

For  the  second  "want"  of  the  infant,  namely,  food, 
ample  provision  has  been  made  by  nature  in  an  ap- 
paratus admirably  adapted  to  its  requirements. 

It  is  evident  from  the  anatomy  of  the  infant  that 
he  is  especially  adapted  for  the  act  of  nursing.  This 
the  infant  does  instinctively. 

That  no  fully-developed  milk  is  found  in  the 
breasts  at  the  time  of  birth  has  been  generally  ac- 
cepted as  conclusive  evidence  that  the  new-born  child 
is  in  no  immediate  need  of  food.  In  fact,  his  deport- 
ment, if  undisturbed,  suggests  the  need  of  rest  during 
the  first  forty-eight  hours  after  birth.  This  belief  is 
so  universal  that  attempts  at  feeding  before  nature 
has  furnished  the  supply  have  not  met  with  general 
approval. 

However,  it  is  recommended  that  the  child  be  put 
to  the  breast  early  for  two  reasons:  First,  to  stimu- 
late milk  secretion ;  and,  second,  in  the  belief  that  the 


NATURAL  FOOD 


57 


first  secretion  (colostrum)  promotes  early  evacua- 
tion of  the  bowel.  Probably,  by  so  doing,  the  child 
secures  a  little  of  the  water  so  much  needed  at  this 
time. 

The  infant's  habitual  loss  in  body  weight  during 
the  first  days,  as  shown  by  tables  on  growth,  has  been 
regarded  by  some  as  unnecessary.  In  fact,  it  is 
claimed  to  be  unfortunate,  as  interfering  with  the  rate 
of  subsequent  growth.  On  this  account  'some  physi- 
cians recommend  that  nourishment  be  supplied  during 
the  first  two  days.  This  is  usually  unnecessary,  how- 
ever. 

If  the  milk  is  slow  in  coming  the  baby  may  be  given 
on  the  second  day,  every  four  hours,  a  tablespoonful 
of  boiled  water  slightly  sweetened  with  milk  sugar. 
Caution:  If  this  procedure  lessens  his  eagerness  for 
the  breast,  it  should  be  discontinued,  as  much  depends 
upon  his  early  learning  to  nurse. 

Intelligent  control  or  supervision  of  the  act  of  suck- 
ling averts  or  corrects  many  evil  effects  of  its  abuse 
when  left  entirely  to  instinct.  A  few  rules  may  be 
formulated,  the  observation  of  which  is  manifestly 
important  in  the  hygiene  of  nutrition. 

(i)  Asepsis  must  be  observed,  since  one  of  the 
commonest  causes  of  infantile  disorders  is  infections 
introduced  into  the  stomach.  To  this  end  the  nipple, 
as  well  as  the  infant's  mouth,  for  the  first  few  weeks, 
must  be  cleansed  before  and  after  nursing.  Milk  re- 
maining exposed  to  the  air  shortly  swarms  with  micro- 


Loss  of 

Weight 


Rules  for 
Control 
of  Nursing 


58  CARE  OF  CHILDREN 

organisms,  many  of  which  cause  disease  when  intro- 
duced into  the  digestive  tract  of  the  infant.  Even 
the  milk  in  the  orifices  of  the  ducts  often  becomes  in- 
fected, hence  the  expression  of  a  few  drops  is  recom- 
mended before  each  nursing. 

In  this  connection  it  should  be  remembered  that 
little  or  no  hydrochloric  acid  is  secreted  in  the  stom- 
ach of  the  infant  for  several  months.  This  acid  in 
the  gastric  'juices  of  the  adult  kills  almost  all  the 
germs  introduced  with  food.  The  absence  of  such 
a  safeguard  necessitates  special  care  to  exclude  the 
germs  of  decomposition  and  disease  from  the  intes- 
tinal tract  of  the  infant. 
Frequency  (2)     The  infant  should  be  put  to  the  breast  every 

tivo  hours  during  the  day  and  once  or  twice  at  night 
during  the  first  six  weeks.  From  six  weeks  to  three 
months  the  interval  between  feedings  should  be  in- 
creased to  two  and  one-half  hours.  Between  the  third 
and  sixth  month  the  interval  should  be  increased  to 
three  hours,  giving  seven  feedings  from  5  A.  m.  to  11 
p.  mv  inclusive.  Night  feeding  may  be  discontinued. 
Six  feedings  a  day  should  be  sufficient  for  a  child  at 
six  months.  By  the  end  of  the  year  he  may  be  accus- 
tomed to  five. 

If  sleeping,  he  should  be  wakened  at  the  proper 
time  for  nursing  until  the  habit  becomes  established. 

If  the  milk  is  abundant  the  breasts  should  be  used 
alternately  at  first;  later,  the  child  may  need  both 
breasts  at  a  feeding. 


NATURAL    FOOD 


59 


Disturbed  digestion  is  the  common  result  of  too 
frequent  or  irregular  feeding.  A  certain  definite  time 
is  necessary  for  the  disposition  of  an  ingested  meal. 
After  this  an  interval  of  rest  is  required  for  the  proper 
re-establishment  of  the  digestive  function.  Nothing 
is  more  abhorrent  to  nature  than  "meals  at  all  hours." 
The  practice  of  the  mother  sleeping  with  the  babe  on 
her  arm  and  quieting  his  restlessness  throughout  the 
night  by  offering  the  breast  is,  unfortunately,  too 
prevalent,  the  result  being  that  instead  of  receiving 
one  definite  feeding,  the  helpless  infant  is  made  the 
victim  of  a  perverted  instinct,  and  sooner  or  later  may 
be  permanently  injured. 

The  digestive  process  is  one  of  varied  stages,  each 
dealing  with  a  changed  condition  in  the  mass  of  food 
taken.  It  is  apparent  from  this  that  some  of  the 
digestive  secretions  which  make  their  appearance  only 
as  certain  stages  of  the  digestive  process  are  reached, 
are  not  at  all  suitable  for  freshly  ingested  food.  Prob- 
ably no  vicious  practice  presents  such  vexatious  prob- 
lems in  our  efforts  at  correction  as  the  results  of  too 
frequent  feeding. 

After  convalescence,  the  night  nursing,  like  that  of 
the  day,  should  be  accomplished  with  the  mother 
seated  in  a  comfortable  chair,  and  as  soon  as  through 
the  baby  should  be  "changed"  if  necessary,  and  re- 
turned immediately  to  his  crib.  In  this  way,  the 
mother,  as  well  as  the  baby,  secures  the  maximum  of 
unbroken  rest. 


Meals  at 
all  Hours 


Position 
in  Nursing 


6o 


CARE  OF  CHILDREN 


Time    of 

Nursing 


Mother   to 

Control 


(3)  The  time  occupied  in  nursing  and  the  quan- 
tity taken  should  be  controlled  by  the  mother.  The 
differences  in  the  formation  of  the  nipple  and  in  the 
supply  of  milk  in  different  mothers  affects  nursing 
more  or  less.  There  is  a  difference,  too,  in  the  nurs- 
ing energy  of  different  infants,  so  that  one  infant 
will  occupy  half  an  hour  in  securing  his  dinner,  while 
another  may  gorge  himself  in  ten  minutes.  The  act 
of  nursing  in  its  perfection  is  the  result  of  the  mutual 
co-operation  of  mother  and  child.  A  child  can  not 
properly  nurse  the  passive  breast  of  a  sleeping  or 
even  inattentive  mother. 

In  breasts  where  the  nipple  formation  is  imperfect, 
making  the  nursing  laborious  to  the  infant  or  painful 
to  the  mother,  or  when  milk  secretion  is  tardy  or  in- 
sufficient, the  mother  should  aid  and  encourage  the 
babe  by  placing  herself  in  full  harmony  with  the 
pleasurable  duty  of  the  moment,  and  endeavor  to 
secure  a  full  response  to  the  stimulating  appeal  of  the 
tiny  solicitor  for  a  better  supply. 

When  the  milk  flows  too  freely,  or  in  case  of  in- 
fants who  nurse  with  such  avidity  that  the  process 
from  beginning  to  end  resembles  a  struggle  against 
suffocation,  the  mother  should  control  the  outflow. 
This  may  be  done  by  dexterous  manipulation  of  the 
nipple  between  the  fingers,  by  withdrawing  from  the 
mouth,  or  by  diverting  the  baby's  attention. 

It  is  safe  to  say  that  twenty  minutes  should  be  given 
to  each  nursing.    Too  rapid  feeding  throws  into  the 


NATURAL    FOOD 


61 


stomach  a  large  quantity  of  food,  with  the  result  of 
over-distention,  and  hasty  feeding  invariably  means 
otrrfeeding. 

Not  infrequently  the  stomach  resents  this  abuse  by 
immediate  regurgitation  of  a  portion  of  its  contents, 
which  has  led  to  the  erroneous  belief  that  the  stomach 
is  endowed  with  some  quality  which  enables  it  to  re- 
ject superfluous  food.  That  this  is  a  pernicious  error, 
the  frequent  occurrence  of  gastric  dilatation  and  intes- 
tinal indigestion  is  ample  evidence.  A  little  sterilized 
water  given  before  nursing  frequently  prevents  the 
over-ingestion  of  milk.  Instinct  is  not  always  a  guide 
as  to  the  amount  a  child  should  nurse. 

(4)  Give  zvater  systematically  and  freely.  The 
baby's  food,  as  will  be  shown  when  we  consider  the 
composition  of  milk,  is  made  up  of  several  widely 
different  constituents.  Although  all  of  them  are 
essential  for  perfect  nutrition,  one  or  more  may  be 
temporarily  omitted  without  any  immediate  percep- 
tible interference  with  vital  processes.  In  fact,  one 
only  must  be  present  under  all  circumstances,  and 
this  is  water.  Without  water  no  digestion,  absorption 
or  elimination  is  possible.  Water  enters  largely  into 
the  composition  of  the  infant's  food,  milk  containing 
about  88  per  cent.  Water  is  essential  to  peptone  ab- 
sorption, and  many  diseased  conditions  result  from 
an  insufficient  supply. 

The  restlessness  of  an  infant  is  frequently  only  an 
expression  of  his  thirst.     Often  unrequired  and  inju- 


Overf  ceding 


Water 


Thirst 


6a  CARE  OF  CHILDREN 

rious  food  is  forced  upon  an  unwilling  stomach  in 
response  to  the  infant's  appeal  for  water. 
Uric  Acid  Evidences    of   pain,   usually   ascribed    to    intestinal 

colic,  are  too  frequently  indicative  of  uric  acid  irri- 
tation and  point  to  a  need  for  more  water.  Fortu- 
nately the  doping  of  the  baby  with  carminative  "teas" 
for  the  supposed  intestinal  spasm  occasionally  fulfills 
the  needs  of  the  child  through  the  water  of  the  de- 
coction. There  is  very  little  danger  of  giving  a  baby 
too  much  sterilized  water,  as  it  passes  quickly  out  of 
the  stomach  and  is  absorbed.  The  water  should  be 
given  at  blood  heat,  either  with  a  spoon  or  from  a 
nursing  bottle. 

Composition    of    Mother's    Milk 

Milk  is  an  emulsion  of  innumerable  minute  globules 
of  fat  floating  in  plasma.  Among  the  globules  are 
smaller  particles  of  proteid  matter. 

All  the  five  principal  classes  of  foods  are  found  in 
milk,  viz.:  water,  fats,  proteids,  carbo-hydrates,  (milk- 
sugar),  and  salts. 

A  symmetrical  development  requires  not  only  the 
presence  of  all  the  constituents,  but  that  they  should 
maintain  a  certain  definite  quantitative  ratio. 
importance  Although  perfect  nutrition  is  dependent  upon  the 
presence  of  all  these  food  principles,  life  may  be  main- 
tained for  a  longer  or  shorter  time  if  one  or  more  be 
omitted  from  the  diet,  always  excepting  water.  Thus 
an  infant  may  exist  for  a  time  on  water  and  sugar,  as 
a  solution  of  sugar  of  milk,  or  on  water  and  proteids, 
or  on  water  and  salts;  the  result,  however,  in  each 


NATURAL  FOOD  63 

case  invariably  showing  the  deficiency  of  the  constit- 
uents in  impaired  nutrition.  (This  is  so  well  recog- 
nized that  the  absence  of  one  or  morcof  these  essen- 
tial constituents  is  not  infrequently  determined  by  the 
condition  of  the  infant.) 

The  proteids  furnish  the  only  source  from  which  Proteidi 
the  tissues  obtain  nitrogen,  without  which  no  proto- 
plasm can  exist,  nor  cell  life  be  possible.  Insufficient 
nitrogen  means  interrupted  gain  in  body  weight,  les- 
sened muscular  force,  anaemia  with  the  weakened 
heart's  action,  arrested  secretions  and  all  the  evi- 
dences of  lowered  nutrition. 

The  fats  are  necessary,  not  only  to  maintain  the  Fats 
body  heat,  but  to  aid  in  the  formation  of  bone  and 
nerve  tissue.  Fat  also  maintains  the  healthy  function 
of  the  lower  bowel  by  promoting  the  passage  of  the 
faeces.  A  deficiency  of  fat  produces  lesults  distinctly 
characteristic  of  impaired  nutrition  so  uniform  as  to 
have  been  classified  under  the  one  term,  rachitis. 

Sugar  furnishes  muscular  energy  and  heat  and  in-     sugar 
creases  the   formation  and  deposition  of  fat,   sugar- 
fed  babies  frequently  showing  a  remarkable  plump- 
ness, even  though  fat  and  proteids  are  low  in  the  food. 

The  fourth  group — the  salts — principally  those  of     saitr 
lime,  phosphorus,  potash,  soda  and  a  trace  of  iron, 
forms  a  small  but  fairly  uniform  and  very  important 
percentage  of  the  total  constituents. 

A  deficiency  in  any  of  these  salts  shows  quickly  in 
the  impairment  of  the  child's  bony,  nervous,  muscular, 
circulatory  or  digestive  system. 


64 


CARE  OF  CHILDREN 


Water 
Absolutely 

Necessary 


Variation 
in  Quality 


Teat  of 
Food 


Were  all  the  other  ingredients  present  in  normal 
mother's  milk  in  proper  proportions,  the  absence  of 
water  would  render  them  valueless  for  food.  It  is 
only  in  a  state  of  solution  that  these  substances  can 
undergo  digestion  in  the  intestines  of  the  infant.  The 
normal  secretions  of  the  digestive  tract  are  relatively 
scant  in  proportion  to  the  enormous  work  accom- 
plished during  the  growing  period.  Hence,  the  neces- 
sity for  water  at  all  stages.  Attention  is  again  called 
to  what  has  been  said  in  the  preceding  pages,  as  the 
importance  of  the  demand  for  water  can  hardly  be 
overestimated. 

As  before  stated,  normal  mother's  milk  is  made  up 
of  these  five  constituents ;  moreover,  they  maintain 
a  fairly  constant  percentage  relationship.  Frequent 
variations,  however,  are  observed  in  normal  milk,  as 
in  different  mothers,  or  in  the  same  mother  at  different 
times,  or  in  the  same  mother  in  the  different  breasts, 
or  in  the  same  breast  at  the  same  nursing  drawn  at 
different  times,  as  fore,  middle  and  last  milk. 

Of  these  constituents  the  percentage  of  fat  is  sub- 
ject to  the  widest  variation ;  next,  the  proteids ;  the 
milk  sugar  and  salts  showing  little  change.  Nor 
would  these  variations  be  considered  as  indications  of 
abnormality,  the  only  criterion  being  its  effect  upon 
the  child.  An  infant  at  the  breast,  digesting  well, 
gaining  steadily  in  weight  and  strength,  is  getting 
good  milk,  regardless  of  what  the  analysis  may  show. 
It  is  a  fact  of  common  observation  that  the  breast  at 


CHANGING  QUALITY  OF  FOOD 


65 


which  one  infant  thrives  may  not  meet  the  require- 
ments of  another  child  of  the  same  age. 

CHANGING   THE   QUANTITY   AND    QUALITY   OF   THE   MILK 

Milk  secretion  is  subject  to  variations  in  quantity 
as  well  as  in  quality.  In  the  majority  of  mothers  it 
is  regulated  to  meet  the  requirements  of  the  infant, 
although  instances  are  not  uncommon  in  which  the 
quantity  is  insufficient.  On  the  other  hand,  it  fre- 
quently occurs  that  the  mother  may  successfully  nurse 
two  infants,  as  in  cases  of  twins,  or  in  wet-nursing  in 
foundlings'  homes.  From  this  it  may  be  inferred  that 
in  some  mysterious  way,  and  to  a  limited  extent,  the 
supply  is  regulated  by  the  demand.  The  growth  of 
large  babies  is  relatively  more  rapid  than  that  of 
smaller  ones,  and  it  would  appear  that  to  a  certain 
degree  there  is  an  automatic  adjustment  of  the  quan- 
tity of  milk  to  the  needs  of  the  child. 

It  is  a  question  whether  the  daily  quantity  of  milk 
can  be  increased  by  any  medical  agent.  However,  the 
milk  secretion  is  quite  sensitive  to  many  influences, 
both  as  to  its  quantity  and  composition. 

A  so-called  "dry  diet"  in  which  there  is  a  deficiency 
of  water,  usually  diminishes  the  secretion,  while,  on 
the  other  hand,  it  may  be  increased  by  a  liberal  allow- 
ance of  water,  milk  and  other  fluids. 

The  secretion  of  milk,  when  scanty,  may  be  in- 
creased by  any  agency  that  increases  normal  meta- 
bolism (digestion  and  assimilation)  ;  as  diet,  exercise, 
massage,    electricity,    fresh    air,    sunlight,    congenial 


Variations 
in  Quantity 


Increasing 
Quantity 


66 


CARE  OF  CHILDREN 


Mental 
Attitude 


Changing 
the  Fats 


surroundings,  freedom  from  physical  discomfort  and 
an  equable  temperament. 

Sudden  emotion,  as  grief,  anxiety,  anger,  fear,  or 
anything  that  produces  shock  or  profoundly  impresses 
the  nervous  system,  may  not  only  diminish  the  secre- 
tion, but  occasionally  cause  total  suppression. 

Regularity  should  be  observed  in  putting  the  child 
to  the  breast,  even  though  there  be  little  evidence  of 
milk  as  the  secretion  is  undoubtedly  promoted  by  the 
act  of  nursing. 

Attention  is  again  called  to  the  mental  attitude  of 
the  mother  during  nursing,  as  influencing  the  quan- 
tity of  milk.  It  must  not  be  forgotten,  however,  that 
over-anxiety  to  produce  defeats  its  very  object. 

Loss  of  fluids  from  any  cause,  as  copious  perspira- 
tion, menstruation  or  diarrhoea,  may  lessen  the 
amount  of  the  milk. 

The  relative  proportion  of  the  constituents  of  the 
milk  may  be  influenced  by  variations  in  the  hygiene 
of  the  mother,  especially  in  the  diet.  The  former  be- 
lief that  the  fat  of  the  milk  was  increased  by  the  fat 
eaten  has  been  repeatedly  disproved  by  actual  experi- 
ment. It  is  believed  to-day  that  the  proportion  of  fat 
in  the  milk  depends  largely  upon  the  amount  of  pro- 
teid  in  the  mother's  food,  increase  or  decrease  in  the 
latter  causing  a  like  change  in  the  former.  The  mere 
eating  of  proteid  food,  however,  is  not  sufficient  to 
produce  a  "rich  milk,"  since  thorough  digestion  and 
assimilation  are  essential  to  fat  production. 


CHANGING  QUALITY  OF  FOOD 


67 


Fat  may  be  scanty  in  the  milk,  not  only  from  an  in- 
sufficiently nitrogenous  diet,  but  also  as  a  result  of 
excess  of  fats  in  the  food.  Examples  are  not  wanting 
of  mothers  who  in  their  efforts  to  enrich  their  milk 
defeat  this  object  by  drinking  too  much  rich  milk  or 
cream. 

A  poorly  nourished  or  rachitic  infant  is  frequently 
seen  at  the  breast  of  the  mother  whose  diet  consists 
largely  of  starchy  foods.  The  substitution  in  this 
case  of  a  diet  of  eggs  for  breakfast,  meat  for  dinner 
and  supper,  with  a  cup  of  beef  broth  between  times, 
and  a  limited  supply  of  vegetables  and  sweets  will 
almost  invariably  show  an  increased  percentage  of  fat 
in  the  milk,  with  subsequent  improvement  in  the 
nutrition  of  the  child. 

It  occasionally  occurs  that  the  infant  shows  the 
effects  of  excessive  fat  in  the  so-called  "fatty  diar- 
rhoeas," in  which  fat  is  seen  in  the  diapers  in  glisten- 
ing masses  or  floating  on  the  surface  of  the  washing 
water.  Again,  in  the  "spitting  babies,"  who  regurgi- 
tate their  food  shortly  after  nursing,  analysis  of  moth- 
er's milk  shows  sometimes  as  high  as  seven  or  even 
nine  per  cent  fat.  In  such  cases  meats  should  be  re- 
stricted and  vegetables  and  breadstuffs  substituted  in 
the  mother's  diet. 

The  proteids  are  rarely  low  except  in  cases  of  ex- 
haustion or  debility,  as  from  sickness  or  insufficient 
food.  In  this  condition  the  milk  is  poor  and  watery, 
there  being  a  deficiency  in  all  the  solids.     In  such 


Too  Much 
Fat 


Changing1 
the   Proteids 


68 


CARE  OF  CHILDREN 


Excessive 
Proteids 


Colostrum 
Milk 


cases  the  hygiene  of  the  mother  requires  a  liberal  diet 
with  all  the  accessories  for  the  improvement  of  her 
general  nutrition.  Here  nitrogenous  foods  are  neces- 
sary to  increase  proteids  in  the  milk.  It  may  happen 
that  the  mother's  milk  in  cases  of  debility  shows  an 
excess  of  proteids  with  a  deficiency  of  other  constitu- 
ents, the  debilitated  infant  exhibiting  evidences  of  in- 
digestion, in  constipation  or  in  diarrhoea  and  vomit- 
ing. 

Excessive  proteids  may  appear,  also,  in  the  milk  of 
the  overfed  mother  of  sedentary  habits  for  whom  ex- 
ercise in  the  open  air  with  reduction  of  diet  is  re- 
quired. Idleness  and  discontent  may  be  replaced  by 
congenial  occupation,  to  the  improvement  of  the  milk 
in  this  respect.  The  relief  of  constipation  or  the  alle- 
viation of  any  bodily  discomfort  may  alone  be  suffi- 
cient. 

Violent  agitation  of  the  nervous  system  of  the 
mother  may  change  the  quality  of  the  milk  almost  in- 
stantly. Quite  frequently,  under  these  circumstances, 
it  resembles  colostrum  in  its  changed  proteids,  low 
fat  and  colostrum  corpuscles.  Instances  are  known 
where  convulsions  and  even  death  to  the  nursling 
have  followed. 

The  secretion  of  the  colostrum  milk  sometimes  fol- 
lows undue  fatigue,  excitement,  anger,  grief,  also 
menstruation  and  conception.  Disturbances  of  diges- 
tion in  the  infant  are  frequently  the  first  intimation  of 


CHANGING  QUALITY  OF  FOOD  69 

pregnancy  in  the  mother.  In  the  event  of  the  above 
disturbances,  the  child  should  be  removed  from  the 
breast  and  artificially  fed  until  the  milk  approaches  the 
normal  as  shown  by  analysis.  Meanwhile,  the  breasts 
should  be  emptied  regularly  by  the  breast  pump. 


SUCTION  BREAST  PUMP. 

Both  quantity  and  quality  of  the  milk  are  influenced  Eftect 
by  the  frequency  of  nursing.  Poor  milk  usually  re-  of  Cursing 
suits  from  irregular  intervals  in  nursing.  The  more 
frequently  the  breasts  are  emptied,  the  higher  will  be 
the  percentage  of  solids,  especially  the  proteids.  The 
infant,  restless  from  indigestion  induced  by  excess  of 
proteids,  often  is  unfortunately  given  the  nipple  at 
short  intervals  to  quiet  him.  The  result  is  increased 
indigestibility  of  the  milk  from  greater  excess  of  pro- 
teids.  What  is  needed  is  water  for  his  thirst,  rest  for 
his  stomach  and  rest  for  the  mammary  glands. 


70  CARE  OF  CHILDREN 

In  conclusion,  a  table  may  best  express  a  summary 
of  the  means  at  our  command  for  regulating  the  com- 
position of  mother's  milk. 

The  percentages  of  sugar  and  salts  vary  but  little. 

The  Percentage  of  Proteid  may  be  Increased  by 

Increased  frequency  of  nursing. 

Increased  liberality  of  proteid   food. 

Insufficient  exercise. 
The  Percentage  of  Proteid  may  be  Diminished  by 

Diminished  frequency  in   suckling. 

Diminished  proteid  food. 

Increased  exercise. 
The  Percentage  of  Fat  is  Increased  by 

Increased  proteid  diet. 
The  Percentage  of  Fat  is  Diminished  by 

Deficiency  of  proteid  food. 

Excess  of  fatty  foods. 

Fasting. 
The   Percentage  of  Water   is   Increased   by 

Increased  fluid  diet. 
The  Percentage  of  Water  is  Diminished  by 

Saline  cathartics. 

Diminished  fluid  diet. 

Care  of         The  nursine  mother  must  keep  herself  in  the  best 

the   Mother  .  .  r 

possible  physical  condition  if  she  would  have  a  healthy, 
contented  baby.  She  should  take  daily  exercise  in  the 
open  air,  simple  food,  and  plenty  of  sleep.  She  should 
keep  free  from  worry,  avoid  too  much  excitement,  un- 
due fatigue  and  late  hours.  Constipation  should  be 
remedied. 


NATURAL  FOOD  71 

VOMITING 

Vomiting  should  never  be  regarded  as  trivial.  It 
should  be  to  the  baby  feeder  as  the  red  light  is  to  the 
engineer.  A  careful  consideration  of  all  the  condi- 
tions may  determine  the  cause,  which  should  always  m 
be  sought,  and  when  found  removed.  With  rare  ex- 
ception, this  cause  will  be  found  in  the  non-observ- 
ance of  the  rules  of  hygiene  outlined  in  these  lessons. 
Although  almost  invariably  the  vomiting  of  infancy 
is  due  to  dietetic  errors,  it  occasionally  ushers  in  some 
of  the  graver  diseases,  such  as  scarlet  fever,  measles, 
meningitis,  cholera  infantum,  etc. 

Whatever  be  the  cause,  no  mistake  will  be  made  if      Diminish 
the  food  is  diminished  in  quantity  or  withheld  entirely 
for  a  time. 

The  regurgitation  of  a  small  quantity  of  milk 
directly  after  a  feeding  is  not  always  an  indication 
of  serious  trouble,  but  may  result  from  overfeed- 
ing and  careless  handling. 

WEANING     AND     SUBSTITUTE     FEEDING 

The  question  of  substitute  feeding  is  of  secondary 
importance  only  to  that  of  lactation.  Conditions  may 
develop  at  any  time  which  render  breast  feeding  im- 
practicable. Progressive  changes  occur  in  the  con- 
stituents of  breast  milk  which  render  it,  after  a  time, 
insufficient  to  furnish  the  material  demanded  by  the 
rapid  growth  of  the  infant.  Moreover,  the  presence 
of  several  teeth,  the  changes  in  the  salivary  secretion, 


7* 


CARE  OF  CHILDREX 


Period    of 
Lactation 


Do   Not 

Wean    for 

Slight 

Cause 


Early 
Weaning 


as  well  as  in  those  of  the  stomach  and  pancreas,  indi- 
cates preparation  for  digestion  of  a  different  class  of 
foods. 

The  changes  in  breast  milk  show  considerable  vari- 
ation as  to  the  time  of  their  occurrence  in  different 
women.  Thus,  one  mother  may  have  exhausted  her 
power  to  produce  good  milk  by  the  end  of  the  seventh 
month ;  while  another  woman  may  continue  to  furnish 
good  milk  until  the  fifteenth  month. 

The  growing  tendency  to  recommend  weaning  upon 
the  slightest  pretext  suggests  the  need  of  more  em- 
phasis upon  the  injunction  not  to  substitute  artificial 
for  breast  feeding  until  it  is  clearly  proven  that  the 
latter  can  not  be  made  to  agree.  However,  the  infant 
should  not  be  deprived  of  his  right  to  a  fair  start  in 
life  by  being  confined  to  the  breast  which  fails  to  fur- 
nish all  the  requisites  for  normal  nutrition. 

Aside  from  the  normal  time  of  weaning,  which 
should  rarely  be  deferred  beyond  the  twelfth  month, 
occasions  may  arise  during  the  first  year  when  the 
decision  must  be  made  as  to  whether  the  child  can 
thrive  on  the  milk  of  his  nurse.  Transient  disturb- 
ances due  to  the  milk  should  not  be  considered  suffi- 
cient cause  for  rejecting  the  breast,  since  many  tem- 
porary disagreements  may  be  corrected  by  attention 
to  the  hygiene  of  the  mother  or  child. 

The  indications  for  early  weaning,  so  far  as  the 
infant  is  concerned,  are  evidences  of  deficiency  in 
normal  development,  which  is  frequently  best  shown 


WEANING 


7i 


by  a  failure  to  gain  in  weight.  However,  weight  gain 
is  not  always  evidence  of  normal  nutrition,  as  many 
rachitic  babies  make  fat  rapidly. 

The  process  of  weaning  should  be  gradual,  the  in- 
fant having  been  accustomed  to  supplemental  feeding 
commencing  with  one  a  day  and  increasing  the  num- 
ber through  a  period  of  several  weeks. 

The  food  selected  for  the  supplemental  feeding 
should  at  first  be  weaker  than  that  for  an  artificially- 


First 

Substitute 
Food 


BREAST  PUMP  WITH   BULB. 


fed  infant  of  the  same  age  and  development.  This 
is  particularly  important  in  the  proteids,  which  in 
cows'  milk  are  much  more  difficult  to  digest.  As  the 
skimmed  milk  contains  most  of  the  proteids,  about 
one-half  of  this  constituent  may  be  replaced  with 
water  in  the  food  formula  for  an  infant  of  the  same 
age.  If  the  new  diet  is  tolerated,  the  skimmed  milk 
may  be  increased  cautiously  from  day  to  day  until  the 
regular  formula  is  used. 

The  season  or  time  of  year  must  be  considered  in 
the  weaning,  as  radical   food  changes  should  not  be 


Time   of 
the  Year 


74 


CARE  OF  CHILDREN 


Menstruation 


made  at  the  commencement  of  or  during  the  heated 
term,  at  which  time  infants  are  especially  susceptible 
to  digestive  disorders.  The  cutting  of  an  unusually 
troublesome  tooth  might  well  delay  the  change  in 
food. 

A  child  should  be  immediately 
removed  from  the  breast  upon  the 
appearance  of  acute  infectious  dis- 
ease in  the  mother  or  upon  well- 
grounded  suspicion  of  the  exist- 
ence of  syphilis  or  tuberculosis.  A 
suitable  wet  nurse  should  be  se- 
cured if  possible,  in  case  the  infant 
is  free  from  syphilitic  infection. 

The  development  of  abscess  ren- 
ders the  affected  breast  unfit  for 
nursing  while  suppuration  con- 
tinues. 

Menstruation  frequently  disturbs  lactation.  Its 
early  appearance  may  not  require  weaning,  but  its 
regular  return  should  suggest  its  advisability.  It  is 
usually  best  to  give  substitute  feedings  during  the 
first  day  of  a  period. 

The  occurrence  of  conception  is  an  indication  for 
the  immediate  removal  of  the  child  from  the  breast, 
as  this  condition  renders  the  milk  insufficient,  if  not 
positively  injurious. 

When  it  becomes  evident  that  substitute  feeding  is 
necessary,  the  question  zuhat  shall  be  substituted  is  of 


Artificial  Nipple  for 

Use  with  Sore 

Breasts 


SUBSTITUTE  FEEDING  75 

the  greatest  importance.  Errors  in  the  management 
of  substitute  feeding  are  probably  responsible  to  a 
greater  extent  than  any  other  cause  for  the  high  infant 
mortality. 

The  best  substitute  is  the  wet  nurse.  The  draw-  '  The  wet 
backs  to  wet-nursing  are  many  and  extremely  trying, 
and  it  is  probably  on  account  of  these  that  this  substi- 
tution is  not  more  frequently  resorted  to  in  this  coun- 
try. The  wet  nurse  should  be  chosen  with  reference 
to  her  temperament,  the  quality  and  quantity  of  her 
milk  and  her  freedom  from  syphilis  or  tuberculosis. 
She  should  be  examined  by  the  family  physician  and 
accepted  only  upon  his  recommendation. 

Should  the  first  wet  nurse's  milk  fail  to  agree,  it 
need  be  no  cause  for  discouragement,  as  in  some  cases 
repeated  trials  are  necessary.  In  case  a  wet  nurse  is 
not  available  it  will  become  necessary  to  adopt  arti- 
ficial feeding. 


ARTIFICIAL   FEEDING 

More  has  been  written  and  said  concerning  artificial 
feeding  during  the  past  ten  years  than  all  other  pedia- 
tric subjects  combined. 

Having  studied  natural  feeding,  we  should  have  a 
fairly  practical  knowledge  of  the  quantity  and  quality 
of  food  required  at  different  ages,  and  also  the  time 
and  method  of  feeding.  That  we  should  keep  close  to 
nature,  both  in  the  composition  and  physical  proper- 
ties of  the  food,  seems  hardly  necessary  to  state.  Vet 
we  see  infants  fed  (?)  on  compounds  differing  so 
widely  from  those  which  their  organs  are  prepared  to 
digest  that  it  is  surprising  so  many  survive. 
m£!!5£!?         The  stomach  of  the  infant  at  birth  was  found  to  be 

Dig  est. on 

little  more  than  a  receptacle  for  food  in  which  the 
action  of  rennet  coagulating  the  milk,  prepares  it  for 
the  first  step  in  the  digestive  process. 

As  the  infant  grows  the  capacity  of  the  stomach  in- 
creases rapidly,  its  walls  thicken,  the  glands  develop 
and  pepsin  and  hydrochloric  acid  secretions  gradually 
become  more  abundant.  It  is  not,  however,  until  after 
the  sixth  month  that  the  salivary  and  pancreatic  secre- 
tions develop  to  any  great  extent  the  power  of  con- 
verting the  starch  into  sugar. 

This  conversion  is  necessary  before  cereals  may  en- 
ter largely  into  the  food,  as  nature  has  made  little  or 
no  other  provision  for  the  digestion  of  starch. 

During  the  latter  half  of  the  first  year  the  stomach 
empties  itself  of  a  digested  meal  in  two  or  three  hours, 

76 


COVERED  MILK   PAIL   IN  USE  AT  CONNECTICUT 
AGRICULTURAL  COLLEGE 

The  first  jets  from  each  quarter  ot  the  udder  are  drawn  into  a  cup 
and  discarded 


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ARTIFICIAL  FEEDING 


77 


the  time  depending  upon  the  quality  of  the  food  taken, 
cow's  milk  requiring  the  longer  time. 

That  a  very  large  percentage  of  the  food  is  ab- 
sorbed in  the  normal  infant  normally  fed,  is  shown  by 
analysis  of  the  faeces.  As  a  result  of  observations 
upon  infants  fed  wholly  upon  milk,  it  is  stated  that 
the  faeces  consist  of  84  to  86  per  cent  water;  that 
digestion  and  absorption  of  proteids  in  the  alimen- 
tary canal  are  so  efficient  that  but  little  is  lost;  that 
the  whitish  flakes  and  clots,  nearly  always  seen,  are 
composed  largely  of  fat,  fatty  and  lactic  acids  in  com- 
bination with  lime. 

Milk  acids  are  always  found  and  to  their  presence 
are  attributed  the  slightly  acid  smell  and  reaction. 
Fermentation  of  milk  sugar  leads  to  the  development 
of  carbon-dioxide  and  hydrogen,  which  are  the  prin- 
cipal gases  in  the  intestinal  tract  of  a  healthy  infant 
fed  purely  on  milk,  foul-smelling  gases  being  absent. 

Though  the  amount  of  faeces  varies  much  in  in- 
fants, yet  three  per  cent  of  the  milk  taken  is  the  aver- 
age proportion.  The  fecal  discharges  after  the  first 
few  days  are  an  orange  yellow,  frequently  turning  to 
green  on  exposure  to  air,  are  of  the  consistency  of 
batter  and  homogeneous  throughout.  They  average 
from  three  to  five  movements  daily.  These  character- 
istics vary  somewhat  with  the  quality  of  food  taken 
and  the  completeness  of  the  digestive  process. 

The  urine  increases  from  about  six  ounces  at  the 
end  of  the  first  week  to  eight  or  sixteen  ounces  at  six 


Completeness 
of  Digestion 


Fecal 
Discharges 


78 


CARE  OF  CHILDREN 


Essentials 

in    Substitute 

Feeding 


Composition 


Anti-Scorbutic 


Quantity 


months.  There  is  considerable  variation,  however,  de- 
pendent upon  the  secretions  from  the  skin  and  bowels 
and  the  amount  of  fluids  taken.  The  marked  tend- 
ency to  urination  is  variable,  occurring,  sometimes 
every  hour  during  the  day  and  twice  or  thrice  at 
night,  while  at  othei  times  several  hours  may  elapse 
without  urination.  The  urine  is  usually  light  in  color, 
of  low  specific  gravity,  1.004  to  1.010,  and  in  health 
rarely  stains  the  diaper. 

A  few  "essentials"  from  Cheadle  may  be  of  value 
in  assisting  the  student  to  a  practical  application  of 
some  of  the  principles  already  indicated. 

First — The  food  must  contain  the  different  ele- 
ments in  the  same  proportions  as  found  in  human  milk, 
viz. :  proteids,  1  to  2  per  cent ;  fats,  3  to  4  per  cent ; 
milk  sugar,  6  to  7  per  cent ;  salts,  j\  per  cent ;  water, 
88  per  cent. 

Second — It  must  possess  the  anti-scorbutic  prop- 
erty. Infants  at  the  breast  very  rarely  suffer  from 
scurvy,  that  disease  being  found  among  those  fed 
upon  condensed  or  sterilized  milk,  or  upon  dried  or 
evaporated  preparations.  Prompt  recovery  usually 
occurs  with  the  food  unchanged,  except  the  discon- 
tinuance of  sterilization.  Fresh  milk  possesses  this 
anti-scorbutic  element,  but  not  in  large  proportion, 
for  milk  in  extreme  dilution  will  not  prevent  the  de- 
velopment of  scurvy. 

Third — The  total  quantity  in  twenty-four  hours 
must  represent   the   equivalent   in    nutritive   value   of 


ARTIFICIAL  FEEDING  79 

from  one  to  three  pints  of  human  milk,  according  to 
age. 

Xo  fixed  arbitrar\  rule  can  be  given  for  all  chil- 
dren. Careful  observation  of  the  infant  as  to  whether 
he  rejects  some  of  his  food  soon  after  taking  it  or 
seems  hungry  half  an  hour  after  feeding,  may  prove 
a  guide.  The  best  indication  that  he  is  receiving  his 
full  equivalent  is  a  steady  weekly  gain  of  two  or  three 
ounces  or  more  in  the  early  months. 

Fourth — //     must    not    be    purely    vegetable,    but      Animal 

*  .  Origin 

must  contain  a  large  proportion  of  animal  matter. 

Most  vegetable  substances  are  deficient  in  proteids 
and  yield  but  a  small  quantity  of  fat.  Moreover,  it  is 
known  that  the  infant  does  not  assimilate  them  as 
easily  and  fully  as  those  derived  from  animal  sources, 
even  though  these  ingredients  be  supplied  in  the 
proper  percentages. 

Fifth — It    must   be   in    a   form   suited   to    infantile      Fluid 
digestion. 

The  digestive  organs,  it  will  be  remembered,  have 
only  recently  assumed  their  function  and  are  de- 
signed to  deal  solely  with  the  bland,  dilute  and  easily- 
dissolved  nutriment  of  mother's  milk.  ■  In  the  natural 
method  of  feeding,  the  infant  gets  his  nourishment  in 
the  same  form  at  every  meal ;  so  in  artificial  feeding 
variety  is  not  desirable. 

As  the  walls  of  the  stomach  are  lacking  in  muscular 
power  and  the  glands  produce  but  little  secretion,  it 
is  evident  that  it  is  not  right  to  ask  this  organ  to  deal 


80  CARE  OF  CHILDREN 

with  large  masses  -of  solid  or  semi-solid  matter.  Sol- 
ids can  be  digested  only  in  a  state  of  minute  subdivi- 
sion. 

sterile  Sixth — //    must    be    as    nearly    sterile    as   possible. 

Infants  are  extremely  susceptible  to  stomach  and  in- 
testinal disorders,  having  little  resistance  to  bacteria 
""  and  their  poisons.  The  products  of  fermentation  are 
highly  irritating  and  the  sensitive,  unstable  nervous 
system  of  the  infant  may  be  profoundly  affected  there- 
by. The  gastric  secretions  of  the  infant  do  not  con- 
tain the  protecting  hydrochloric  acid  of  the  adult. 

Ogj£  Cow's  milk,  on  account  of  its  cheapness  and  the 
abundant  supply,  is  the  most  available  substitute  for 
mother's  milk.  The  proneness  to  stomach  disorders 
and  the  great  mortality  among  the  bottle-fed  babies 
has  led  to  a  systematic  study  of  cow's  milk.  As  a  re- 
sult of  this  study,  some  of  the  reasons  why  cow's  milk 
does  not  meet  all  the  requirements  of  the  infant  may 
be  shown.  The  results  of  recent  analyses  give  the  con- 
stituents of  cow's  and  mother's  milk  as  follows: 

Composition   of   Milk 

Average   Composition.  Cow's.  Mother's. 

Per    Cent.  Per    Cent. 

Specific   gravity    1.032     1030 

Total    solids    14-13 13-12 

Proteids    400 150 

Fat     4.00 4.00 

Sugar     4.50 6.50 

Salts     070..: 0.15 

Reaction    Acid* Alkaline 

Bacteria  Swarming  with*  ....     None 

♦This  refers  to  cow's  milk  as  it  reaches  the  consumer. 


ARTIFICIAL  FEEDING 


Sr 


It  will  be  seen  at  a  glance  that  the  milks  differ  but 
little  in  specific  gravity,  in  the  quantity  of  their  total 
solids  and  water,  and  in  their  percentage  of  fat ;  more 
widely  in  their  salts,  sugar  and  proteids ;  most  widely 
in  regard  to  chemical  reaction  and  presence  of  bac- 
teria. 

The  sugar  in  cow's  milk  is  identical  with  that  in 
breast  milk.  The  fats  are  nearly  the  same,  although 
those  in  breast  milk  are  in  more  finely  divided  par- 
ticles and  more  easily  digested.  It  is  in  the  proteids 
that  the  greatest  difference  comes,  the  percentage  be- 
ing much  higher  in  cow's  milk  and  the  composition 
different.  The  proteids  of  both  cow's  and  mother's 
milk  are  made  up  chiefly  of  casein  and  albumen  (lac 
albumen),  but  the  relative  porportion  of  the  casein  to 
the  albumen  in  cow's  milk  is  about  6  to  I,  and  in  breast 
milk  is  about  i  to  i.  Even  the  casein  in  the  two  milks 
is  not  of  identical  composition ;  that  in  cow's  milk 
coagulates  in  much  denser  and  less  digestible  clots. 
The  nitrogenous  substances  called  "extractives"  differ 
in  the  two  milks  and  the  mineral  parts — the  salts — are 
not  the  same.  Thus  it  is  apparent  that  cow's  milk 
can  not  be  so  modified  as  to  be  identical  with  mother's 
milk.  The  best  we  can  do  is  to  approximate  nature's 
supply  as  nearly  as  possible. 

Most  of  the  disturbances  of  infants'  digestion  are 
traceable  directly  to  proteids;  their  excess  in  cow's 
milk  being  the  principal  factor  in  its  disagreement. 
It  is  usual  to  reduce  the  percentage  of  proteids  by  the 
addition  of  water. 


Differences 
from  Mother's 
Milk 


Proteids 
Cause  of 
Trouble 


82 


CARE  OF  CHILDREN 


Modified 

Milk 

Laboratories 


Bacteria 

the  Cause 

of  Disorders 


Safe    Milk 


In  this  dilution,  however,  the  nutritive  value  of  the 
milk  suffers  from  a  diminution  of  fats  and  sugars. 
Consequently  it  is  necessary  that  the  percentage  of 
sugar  and  fats  be  maintained  by  the  addition  of  sugar 
of  milk  and  cream. 

Laboratories  for  this  modification,  like  those  of  the 
Walker-Gordon  Co.,*  have  been  established  in  the 
leading  American  cities,  to  which  orders  are  sent  for 
definite  percentages  of  modified  milk,  as  drugs  are 
ordered  by  prescription  from  a  pharmacy.  The  physi- 
cian may,  at  will,  control  the  amount  of  different  in- 
gredients, varying  their  percentages  to  meet  the  vary- 
ing requirements  of  the  little  patient. 

That  many  disorders  of  infancy  are  due  to  the 
presence  of  bacteria  in  cow's  milk  is  no  longer  a  mat- 
ter of  doubt.  In  addition  to  infection  from  the  pos- 
sible presence  of  such  germs  as  those  of  tuberculosis, 
typhoid  fever,  scarlet  fever,  diphtheria,  etc.,  it  should 
be  emphasized  that  the  proneness  of  cow's  milk  to 
decomposition  with  its  effects  upon  the  nursling  is 
one  of  the  greatest  dangers  of  milk  feeding.  Hence, 
the  hygienic  dairy  management  becomes  a  question  of 
the  highest  importance. 

It  has  been  proved  that  milk  production  may  be  so 
guarded  as  to  furnish  a  product  comparatively  free 
from  bacteria.     As  an  example  of  what  scrupulous 


*The  Walker-Gordon  Co.  have  laboratories  or  stations  in  the  follow- 
ing cities:  New  York,  Boston,  Chicago,  Philadelphia.  Washington, 
Baltimore,  Buffalo,  Cincinnati.  Cleveland,  Detroit.  Grand  Rapids. 
Milwaukee,  Pittsburg,  St.  Louis,  Atlantic  City,  Princeton,  Newark, 
Elizabeth,  Montreal,  Can.,  Ottawa,  Can.,  London,  Eng.  . 


ARTIFICIAL  FEEDING  83 

care  and  cold  can  accomplish  in  producing  bacteria- 
free  milk,  ma)-  be  mentioned  the  exhibits  of  a  number 
of  American  dairies  at  the  Paris  exposition  in  1904. 
Milk  and  cream  were  shown  that  remained  sweet  for 
several  days  after  the  journey  of  ten  days  or  more. 
The  officials  found  it  hard  to  believe  that  no  preserva- 

o°o  opv° }:  •       o.  °r^°"9} 

Uo    .0    0V'n„°K      n  '-zl>S  C 


a 

MICROSCOPIC  APPEARANCE  OF  MILK. 

a.  Pure  milk.      6.  After  standing  in  a  dirty  dish  for  some  hours  in  a 
warm  room,  showing  many  varieties  of  bacteria. 

tives  had  been  added  or  treatment   given  until   con- 
vinced by  analysis  and  by  proof. 

The  same  care  in  the  selection  of  the  cow  is  rec-      selection 
ommended  as  in  the  selection  of  the  wet  nurse ;  the      0f  Cows 
same  details  in  her  hygiene  as  well  as  in  the  antiseptic 
care  of  the  milk  will  insure  milk  that  is  practically 
sterile. 

In  the  choice  of  the  family  cow  three  requisites  at 
least  should  be  kept  in  view.  First:  The  quality  of 
the  milk.     Second:     The  constitution  of  the  animal, 


Jerseys 


84 


CARE  OF  CHILDREN 


her  hardihood  and  freedom  from  disorders  and  her 
adaptability  to  variations  in  climate  and  food.  Third: 
Her  temperament  and  freedom  from  disturbances  due 
to  accidental  causes. 

Of  many  types  distributed  throughout  the  country 
we  will  discuss  but  three,  viz.,  the  Jersey,  the  Hol- 
stein  and  the  Durham. 

The  Jersey  gives  a  fair  quantity  of  milk,  exceed- 
ingly rich  in  cream.     In-breeding,  however,  has  made 


I  2345  6789101112  0  1*15161718192021  22 


6% 

'4 

VARIATION  IN  PERCENTAGE  OF  CREAM 
IN  ONE  COW'S  MILK. 

her  delicate  and  quite  susceptible  to  diseases,  as  tuber- 
culosis, etc.,  and  though  quite  gentle  she  is  nervous 
and  sensitive.  The  "fats  of  Jersey  milk  differ  some- 
what from  those  in'  other  milks  and  the  globules  of 
fat  are  larger,  thus  making  it  less  digestible. 

Hoi»teins  The  Holstein  is  docile,  hardy  and  the  greatest  of 
all  milkers,  but  the  milk  is  low  in  the  percentage  of 
cream  and  proteids. 

Durhams  The  third  type,  the  Durham,  undoubtedly  is  the 
best,  as  she  is  a  good  feeder,  of  placid  temperament, 
and  yields  a  large  quantity  of  very  good  milk. 

In  the  best  of  cows,  however,  the  milk  varies  from 
time  to  time  in  quantity  and  quality  under  the  chang- 


<s 


FAT  GLOBULES  IN  HUMAN  MILK 
Storrs  Agricultural  Experiment  Station,  Bulletin  No.  31 


c 
o 


*  r  *    •      ^ 


6 
0 
,00  o 


>£ 


.^  ::>*<# 


tf         6 


0  O    o 


^^   *% 


o 


"*■-'-'  Oft         ' 

FAT  GLOBULES  IN  HOLSTEIN  MILK 


FAT  GLOBULES  IN  JERSEY  MILK 


ARTIFICIAL  FEEDING  85 

ing  influences  of  food,  care  and  surroundings,  so  that 
the  popular  idea  of  the  great  value  of  a  "one  cow's 
milk"  supply  for  the  baby  is  erroneous.  The  mixed 
product  of  a  herd  secures  a  greater  uniformity  in  the 
quality  and  the  percentage  of  constituents. 

The  selection  of  the  dairyman  should  depend  upon      The  Baby's 
his  known  methods  of  handling  his  herd  and  its  prod- 


THE   COVERED   MILK  PAIL. 

ucts.  Does  he  select  his  cows  upon  the  principles 
above  enumerated?  Is  his  herd  regularly  inspected 
by  a  competent  veterinarian  for  evidences  of  tuber- 
culosis or  other  disease?  Are  the  animals  properly 
fed,  watered  and  pastured?  Are  they  comfortably 
housed  in  stables  that  may  be  cleaned  daily  and  regu- 
larly whitewashed?  Are  the  milkers  kind,  intelligent, 
cleanly  and  conscientious?  Is  the  cow  cleaned  and 
her  udder  washed  before  each  milking?  Is  the  first 
teat  full  of  milk  discarded  and  the  remainder  received 


Milkman 


86 


CARE  OF  CHILDREN 


Importance 
of 

Refrigeration 


Certified    Milk 


in  a  sterilized  pail  through  a  cover  of  cheesecloth  ?  Is 
the  milk  immediately  strained,  bottled  and  placed  in  a 
cooler  which  rapidly  reduces  its  temperature  to  400 
F? 

Rapid  cooling  and  refrigeration  are  fully  as  impor- 
tant as  cleanliness  in  the  production  of  safe  milk,  for 


DIAGRAM  SHOWING  THE  RATE  OF  INCREASE  OF 
BACTERIA  IN  MILK. 


a.  Single  Bacteria. 


I.  Increase  in  24  hours  at  50°  F. 
24  hours  at  70°  F. 


c.  Increase  in 


the  few  bacteria  which  are  present  in  even  the  most 
carefully-cared-for  milk  multiply  with  enormous  ra- 
pidity at  700  F.,  while  they  increase  only  about  five- 
fold in  24  hours  in  milk  kept  at  500  F. 

The  above  enumeration  includes  most  of  the  prin- 
ciples, the  observation  of  which  is  absolutely  neces- 
sary in  the  production  of  milk  suitable  for  baby  feed- 
ing-   The  source  of  supply  should  be  investigated  by 


COVERED  MILK  PAILS,  SHOWING  STRAINER  IN   PLACE 

Sixty-three  per  cent  of  the  dirt  that  woujd  fall  in  an  open  pail  kept  out 

by  the  cover 


COVERED  MILK  PAILS,  SHOWING  COVERS  REMOVED 
Storrs  Agricultural  Experiment  Station,  Storrs,  Connecticut 


ARTIFICIAL  FEEDING 


37 


personal  visit  if  possible.  Some  dairies  in  the  larger 
cities  furnish  milk  especially  for  babies,  called  "certi- 
fied milk,"  at  advanced  price — 12  to  14  cents  a  quart. 
It  will  be  found  economy  to  pay  the  advanced  price 
necessary  for  the  extra  care,  but  it  may  be  well  to 
make  sure  that  the  extra  care  is  given. 

The  cold  sealed  bottle  when  received  at  home  must 
be  placed  at  once  in  a  clean  refrigerator  (free  from 
taint  or  odor  of  other  food  or  vegetables),  and  kept 
stoppered.  The  refrigerator  should  be  kept  at  least  as 
low  as  500  F.  This  point  should  be  tested  with  a 
thermometer. 

Milk  received  in  good 
condition  is  not  infre- 
quently rendered  unfit 
for  infants'  food  by 
careless  handling  in  the 
home.  The  bacteria 
which  by  their  growth 
render  the  milk  unsafe 
are  present  everywhere 
— in  the  air  with  dust, 
in  every  particle  of  dirt, 

in  water,  on  the  hands  and  clothes,  on  all  utensils  and 
vessels.  (See  Household  Bacteriology.)  No  utensil, 
spoon  or  receptacle  should  be  used  which  has  not  been 
sterilized.  Milk  once  poured  out  should  never  be  re- 
turned to  the  bottle,  nor  should  remnants  ever  be  used. 
Flies  (common  carriers  of  infections)  must  be  reli- 
giously excluded. 


THE  FREEMAN  PASTEURIZER. 


Home 
Care  of 
Milk 


88 


CARE  OF  CHILDREN 


Treatment 

of  Unsafe 

Milk 


Pasteurizing 


Sterilizing 


Where  doubt  exists  as  to  the  safety  of  the  milk,  or 
during  hot  weather,  it  may  be  freed  from  germs  by 
pasteurization  or  sterilization.  The  first  is  accom- 
plished by  subjecting  the  milk  for  40  minutes  to  a 
temperature  of  1500  F.  A  pasteurizer  is  on  the 
market  in  which  the  bottles  of  milk  are  placed  and 
sufficient  boiling  water  added  to  bring  the  temperature 
of  the  whole  to  1500  F.*  In  the  absence  of  a  spe- 
cial pasteurizing  apparatus,  a  small  jar  or  cup  about 
the  height  of  a  nursing  bottle  is  filled  with  boiling 
water.  Into  this  the  bottle  containing  one  feeding  of 
milk  is  immersed,  the  projecting  neck  stoppered  with 
sterilized  unabsorbent  cotton.  The  whole  is  then  cov- 
ered with  a  cozy  or  another  jar  to  retard  radiation 
and  allowed  to  stand  40  minutes.  The  temperature 
should  be  tested  in  an  extra  bottle  with  a  thermometer 
until  the  correct  amount  of  boiling  water  to  be  added 
is  determined. 

If  preferred,  the  entire  day's  supply  may  be  pas- 
teurized at  once,  either  in  bulk  or,  better,  in  a  number 
of  separate  feeding  bottles,  which  should  then  be 
cooled  rapidly  and  kept  on  ice  until  used.  It  is  im- 
portant to  cool  the  milk  as  soon  as  possible,  for  the 
spores  not  killed  by  pasteurizing  will  develop  if  the 
milk  is  kept  warm  for  some  time.  The  quickest  way 
to  do  this  is  to  place  the  bottles  in  running  water. 

Sterilization,  i.  e.,  the  destruction  of  both  bacteria 
and  spores,  is  accomplished  by  heating  the  milk  to  a 


*  The  Freeman  Pasteurizer.    Price.  13.50. 


ARTIFICIAL  FEEDING 


89 


temperature  of  2120  F.  (boiling  temperature)  for 
about  an  hour.  This  may  be  done  in  an  ordinary 
double  boiler  or  farina  kettle.  Thus  treated  the  milk 
will  keep  unchanged  for  24  hours  or  so.  If  necessary 
to  protect  it  for  a  longer  period,  as  for  traveling,  ship- 
ping, etc.,  the  process  must  be  twice  repeated  after 
intervals  of  24  hours  each,  when,  if  properly  sealed,  it 
will  remain  bacteria  free  indefinitely. 


THE   ARNOLD  STEAM  STERILIZING   AND  PASTEURIZING 
APPARATUS.    Price,  $3.00  to  85.00. 

It  must  be  borne  in  mind  that  no  amount  of  pasteur- 
ization or  sterilization  can  make  bad  milk  good.  It 
merely  destroys  the  bacteria,  which  by  their  growth 
render  the  milk  unfit  for  infant  food.  The  chemical 
changes  in  the  milk  which,  through  age,  has  begun  to 
deteriorate,  are  beyond  retrieve. 

Milk  should  be  at  first  hand,  like  Caesar's  wife, 
"above  suspicion,"  in  which  case  pasteurization  is  un- 
necessary and  sterilization  is  unwise,  as  the  high  tem- 
perature  changes   it  somewhat  and  renders  it  more 


Milk 
Must  Be 
Fresh 


90 


CARE  OF  CHILDREN 


Supply 

Most 

Important 


difficult  of  digestion.  A  child  fed  continuously  on 
cooked  or  sterilized  milk  is  liable  to  develop  nutri- 
tional disorders,  as  scurvy,  etc. 

The  practice  of  keeping  the  baby's  food  warm  for 
emergencies  is  entirely  wrong,  as  it  favors  the  devel- 
opment of  any  bacteria  present  and  spores  which  are 
not  destroyed  by  pasteurization. 

Because  of  the  limited  field  of  operation  of  the 
milk  laboratory  home  modification  is  of  great  impor- 
tance in  artificial  feeding.  In  this  connection,  the 
protection  of  the  supply  will  ever  continue  to  be  the 
most  important  consideration. 


Apparatus 

and 

Supplies 


MODIFIED     MILK 

To  modify  milk  satisfactorily  in  the  home  the 
mother  or  nurse  must  be  equipped  with  all  necessary 
utensils.  These  include  a  good  ice  box,  two  syphons 
(made  by  heating  and  bending  glass  tubing),  a  ster- 
ilizer or  pasteurizer  thermometer  registering  to  21 2° 
F.,  a  dozen  graduated  feeding  tubes  (large  mouth 
without  shoulder  with  small  lip),  bottle  brifshes,  ab- 
sorbent cotton,  straining  gauze,  non-absorbent  cotton 
for  stoppers,  mixing  pitcher,  8-ounce  graduate,  tall 
cup  for  warming  bottle,  three' to  six  black  rubber 
nipples  (to  fit  mouth  of  tubes,  reversible  for  clean- 
ing), bicarbonate  of  soda  and  boric  acid. 

Lime  water  should  be  kept  in  well-corked  bottles, 
as  it  is  soon  changed  by  the  carbon  dioxide  in  the  air 
to  carbonate  of  lime,  which  is  deposited  on  the  sides 


MODIFIED  MILK 


9i 


of  the  bottle.    Milk  sugar  solution  should  be  prepared 
fresh  for  each  day's  supply. 

The  supply  of  food  may  be  prepared  once  or  twice 
in  the  twenty-four  hours,  depending  upon  the  time  of 
milk  delivery  and  number  of  tubes  to  be  used.  The 
milk  should  always  be  kept  on  ice  before  and  after 
preparation. 

All  bottles  and  utensils  should 
be  washed  with  hot  soapsuds, 
then  rinsed  and  boiled  or  steril- 
ized. Nipples  must  be  scrubbed 
inside  and  out  with  soap  and 
water,  rinsed  and  kept  in  a  solu- 
tion of  soda  or  boric  acid  until 
needed  again.  Milk  tubes  when 
filled  should  be  stoppered  with 
non-absorbent  cotton  so  that  in 
cooling  the  air  may  pass 
through.  After  warming  to 
about  lOO°  F.  (380  C.)  by 
standing  the  bottle  in  a  cup  of 
warm  water  the  cotton  is  re- 
placed by  the  nipple. 

After  nursing,  any  food  remaining  in  the  bottle 
must  be  thrown  away.  No  flies  should  ever  touch 
food,  utensils  or  baby. 

Of  course,  the  nurse  will  never  touch  the  nipple 
with  her  lips.  The  temperature  of  the  milk  may  be 
tested  by  allowing  a  few  drops  to  fall  upon  the  back  of 
the  hand.    Eternal  vigilance  is  the  price  of  sterility. 


AN  EIGHT  OUNCE 
GRADUATE. 


Time  of 
Preparation 


Warming 


92  CARE  OF  CHILDREN 

Feeding  The  bottle  should  be  held  inverted  in  the  hand  dur- 
ing the  feeding  so  that  the  babe  will  not  suck  air. 
If  the  milk  flow  is  too  free  the  nipple  may  be  with- 
drawn from  time  to  time  so  that  about  twenty  minutes 
is  consumed  in  the  feeding,  during  which  the  babe 


Nature 


APPARATUS  AND  MATERIALS  FOR  MODIFYING    MILK. 
Walker-Gordon  Co. 

would  better  be  on  the  arm  or  lap  of  the  nurse.    If  the 
milk  does  not  drop  freely  enough  more  holes  should  be 
made  in  the  nipple  by  means  of  a  hot  needle. 
Follow  The  rules  of  feeding  as  to  regularity,  number  and 

length  of  intervals  should  be  about  the  same  as  those 
given  for  infants  at  the  breast.  .Water  between  feed- 
ings is  generally  required,  and  to  a  ravenous  infant 
should  be  freely  given.  The  water  should  be  boiled 
and  cooled  and  may  be  given  from  either  bottle  or 
spoon. 


MODIFIED  MILK  93 

As  a  rule,  artificial  feeding  in  the  normal  vigorous      Composition 
babies   should  be  begun   with   formulae  representing 
low  percentages.     Especially  is  this  true  of  the  pro- 


FEEDING   THK   BABY, 
Showing  Proper  Position  of  Infant. 

teids.  Taking  average  mother's  milk  as  a  standard, 
the  percentage  of  sugar  may  be  about  the  same,  the 
fats  about  half,  and  the  proteids  about  one-third, 
for  the  first  weeks,  remembering  that  temporary  error 


Proteids 

Low  at 

First 


94 


CARE  OF  CHILDREN 


on  the  side  of  underfeeding  is  easier  of  correction 
than  the  more  common  mistake  of  overfeeding. 

The  proteid  in  cow's  milk  is  the  most  frequent 
cause  of  indigestion,  and  this  absolutely  essential  in- 
gredient requires  most  careful  watching.  Since  its 
variation  by  ever  so  little  is  sufficient,  at  times,  to 
determine  results,  it  would  appear  to.  be  the  point 
around  which  the  problem  of  milk  feeding  revolves. 


HYGEIA   PASTEURIZER  AND   STERILIZER. 


Increase 

Strength 

Slowly 


Hence  the  importance  of  the  percentage  method,  both 
on  account  of  its  advantages  for  comparisons  and  in 
its  ready  adaptability  to  the  necessity  for  slight 
changes. 

As  toleration  of  the  new  diet  is  established  a  grad- 
ual increase  may  be  made  in  the  low  constituents 
week  by  week  until  the  ratio  of  ingredients  approaches 
the  standard  of  breast  milk.  The  standard  formulae 
given  later  should  be  used  only  as  a  suggestive  guide 
and  not  as  an  imperative  rule,  since  the  first  test  of 
any  food  formula  is  its  effect  upon  the  baby. 


MODIFIED  MILK 


95 


In  considering  increase  in  the  amount  of  food,  we 
tnust  be  governed  by  age,  size  for  age,  stomach  ca- 
pacity for  age  and  the  infant's  hunger,  but  largely  by 
the  daily  weight  gain  which  should  be  manifest  from 
week  to  week. 

The  increase  in  the  amount  of 
food,  like  that  of  the  percentage 
of  its  constituents  should  never 
be  made  suddenly.  An  ounce 
added  to  the  total  day's  food  in 
early  infancy  means  an  increase 
of  from  6  to  3  per  cent.  This  one 
ounce  increase  should  be  distrib- 
uted among  the  different  tubes, 
i.  e.,  if  there  are  ten  tubes,  about 
one-tenth  of  an  ounce  should  be 
added  to  each.  If  tolerated  for 
several  days  another  advance 
may  be  made  in  quantity.  Four 
consecutive  weeks  should  be  the 
outside  limit  for  an  increase  of  an  ounce  at  a  feed- 
ing, as  the  tendency  will  be  to  far  exceed  the  infant's 
stomach  capacity  by  flooding  him  with  a  too  diluted 
food.  (See  "Capacity  of  the  Stomach,"  page  46.) 
Both  the  amount  at  a  feeding  and  the  strength  should 
not  be  increased  at  the  same  time. 

The  acid  reaction  of  cow's  milk  renders  the  addi- 
tion of  an  alkali  necessary.  For  this  purpose  bicar- 
bonate of  sodium   (baking  soda)  or  lime  water  may 


increase 
Amount 
Gradually 


THE  HYGEIA   NURS- 
ING  BOTTLE. 


Neutralizing- 
Acidity 


96 


CARE  OF  CHILDREN 


be  used  (preferably  the  latter,  of  which  5  to  10  per 
cent  may  be  necessary).     The  lime  water  also  has 

the  important  property  of 
making  the  curds  more  floc- 
culent  and  therefore  more 
easily  digested.  Of  the  so- 
dium bicarbonate,  one  or  two 
grains  to  the  ounce  will  be 
sufficient.  A  solution  of  one 
drachm  of  sodium  bicarbon- 
ate in  a  quart  of  water  has 
the  same  alkaline  strength  as 
lime  water. 

If  the  food  is  to  be  steril- 
ized, sodium  bicarbonate 
should  be  used  or  the  lime 
water  should  be  added  to  the 
tube  afterwards.  Heating 
with  lime  water  brings  about  certain  undesirable 
changes  in  the  milk. 

The  following  formulae  fairly  express  the  com- 
position, amount  and  frequency  of  feeding,  with  the 
length  of  intervals,  for  normal,  healthy  infants  of 
average  weight  and  development; 


FOOD  WARMER  AND 
ALCOHOL  LAMP. 


MODIFIED  MILK 


97 


Formula  1. 

Proteids;  0  22%  Fats;  1.00%  Sugar;  6.50% 
Cream — (16%) : . . .         $  ounce 

First  3  days      Milk  sugar.  .  . ' |       " 

or  Lime  water |       " 

Premature.        Boiled  water 7       " 

Salt small   pinch 

Total  8       ounces 

Feedings,  10  to  12;     Quantity  of  each,  i  to  J  ounce;  Inter- 
vals, 2  hrs. 


1st  week. 


Feedings,  10; 
2  hrs. 


Formula  2. 

Proteids;  0.47%  Fats;  1.00%  Sugar;  6  75% 

Cream — (16%) 1  ounce 

Skimmed  milk 1       " 

Milk  sugar 1       '' 

Lime  water 1       " 

Boiled  water 13      ". 

Salt a  pinch 

Total  16  ounces 

Quantity  of  each,  $  to  2  ounces;  Intervals, 


Formula  3. 

Proteids;  0.58%  Fats;  1.50%  Sugar;  6  50% 

Cream — (16%) \\  ounces 

Skimmed  milk If     " 

2nd  week  Milk  SU^ar X*     " 

ma  week.        Ume  water j|    M 

Boiled  water 20      " 

Salt. 2  pinches 

Total  24^  ounces 

Feedings,  10;     Quantity  of  each,  1  to  2  ounces;  Intervals, 
2  hrs. 


CARE  OF  CHILDREN 


3rd  week. 


Feedings,  10; 
9.  hrs. 


Formula   4. 

Proteids;  0.70%  Fats;  2.005$  Sugar;  6.50% 

Cream — (16%) 4  ounces 

Skimmed  milk 2       " 

Milk  sugar 1 J     " 

Lame  water 2       " 

Boiled  water 24       " 

Salt 2  pinches 

Total  32  ounces 
Quantity  of   each,  2  to  3  ounces;  Intervals, 


4th  &  5th 
weeks. 


Feedings,  10; 
2  hrs. 


Formula  5. 

Proteids;  0.92%  Fats;  3.00%  Sugar;  6.00% 

Cream — (16%) 6  ounces 

Skimmed  milk 2       " 

Milk  sugar 1 J     •' 

Lime  water 2       " 

Boiled  water 22       " 

Salt 2  pinches 

Total  32  ounces 

Quantity  of  each,  2  to  3  ounces;  Intervals, 


,      Formula  6. 

Proteids;  1.15%  Fats;  3.00%  Sugar;  6.00% 

Cream — (16%) 6  ounces 

Skimmed  milk 3       " 

6th,  7th,  8th       Milk  sugar 1$     " 

weeks.            Lime  water 2       " 

Boiled  water 21       " 

Salt 2  pinches 

Total  32  ounces 

Feedings,  9;     Quantity  of  each,  3  to  3$  ounces;  Intervals, 
2}  hrs. 


MODIFIED  MILK  99 

Formula  7. 

Proteids;  1.40%    Fats;  3  50%  Sugar;  6.25% 

Cream — (16%) 7  ounces 

Skimmed  milk 4       " 

«  j  ti.         Milk  sugar 14     " 

Srdmonth.       Lime  w|ter 2*     „ 

Boiled  water 19       " 

Salt 2  pinches 

Total  32  ounces 

Feedings,  8:     Quantity  of  each,  3  to  4  ounces;  Intervals, 
3hrs. 


Formula    8. 

Proteids;  1.50%   Fats;  3.50%  Sugar;  6.75% 

Cream — (16%) l\  ounces 

Skimmed  milk b\     " 

4th  &  5th         Milk  sugar 2      " 

months  Lime  water 2\     " 

Boiled  water 21       " 

Salt 2  pinches 

Total  36£  ounces 
Feedings,  7;     Quantity  of  each,  4  to  5$;  Intervals,  3  hrs. 


Formula  9. 

Proteids;  1.90%  Fats;  4.00%  Sugar;  7.00% 

Cream — (16%) 10  ounces 

Skimmed  milk 10       " 

6th,  7th,  8th       Milk  sugar 2       " 

months.  Lime  water 2A     " 

Boiled  water 18       " 

Salt 2  pinches 

Total  40$  ounces 

Feedings,  6;     Quantity  of  each,  6  to  7  ounces;     Intervals, 
3  hrs. 


ioo  CARE  OF  CHILDREN 

Formula  10. 

Proteids;  2.40%  Fats;  4.00%  Sugar;  6.00% 

Cream—  (16%) 10  ounces 

Skimmed  milk 15      ** 

9th  &  10th        Milk  sugar 1$     " 

months.  Lime  water 2\     " 

Boiled  water 12$     " 

Salt 1  pinch 

Total  40  ounces v 

Feedings,  5;     Quantity  of  each,  7  to  8  ounces;     Intervals, 
3J  hrs. 

Formula   11. 

Proteids;  2.90%  Fats;  4.00%  Sugar;  6.00% 

Cream— (16%) 12  ounces. 

Skimmed  milk 2  4       •■ 

11th  month.       Milk  sugar 1*     » 

Lime  water 3       " 

Boiled  water 9       " 

Salt 1  pinch 

Total  48  ounces 

Feedings,  5;    Quantity  of  each,  7  to  9  ounces;    Intervals, 
3J  hrs. 

Formula   12. 

Proteids;  3.40%  Fats;  4.00%  Sugar;  5.50% 

Cream— (16%) 12  ounces 

Skimmed  milk . .       30      " 

12th  month.      Milk  sugar f     " 

Lime  water 3       M 

Boiled  water 3       " 

Total  48  ounces 

Feedings,  5;    Quantity  of  each,  8  to  10  ounces;    Intervals, 
4  hrs. 


MODIFIED  MILK  ioi 

Formula    13 

Proteids;  4.00%  Pats;  4.00%  Sugar;  5.50% 

Whole  milk 48  ounces 

13th  month.       Milk  sugar $  ounce 

Bicarbonate  of  soda 30  grains 

Total  48  ounces 

Feedings,  5;  Quantity,  8  to  10  ounces;  Intervals,  4  hrs. 


These  formulae  are  intended  only  as  a  suggestive 
guide  in  the  feeding  of  normal  infants  according  to 
ages  specified.  Delicate  babies,  or  those  of  impaired 
digestion,  should  be  given  the  formula  for  younger 
infants. 

These  mixtures  may  be  prepared  from  16  per  cent 
cream,  skimmed  milk,  milk  sugar,  salt,  lime  water 
and  boiled  water. 

Six  ounces  of  16  per  cent  cream  may  be  obtained 
from  a  quart  bottle  of  good  milk  which  has  stood  un- 
disturbed for  six  hours  by  siphoning  away  the  lower 
four-fifths.  This  16  per  cent  cream  may  also  be 
obtained  from  a  reliable  dairyman. 

Milk  sugar  may  be  bought  from  the  druggist  by 
the  pound,  or  more  cheaply  at  wholesale  in  five-pound 
packages. 

Accurate  scales  not  being  available  in  most  house- 
holds, the  milk  sugar  must  be  measured.  As  different 
brands  vary  a  little  in  weight  for  bulk,  it  is  always 
advisable  to  have  the  druggist  weigh  accurately  por- 
tions of  one,  one  and  one-half,  and  two  ounces,  which 
may  be  kept  as  standards.    One  of  the  most  convenient 


Formulae 
for  Normal 
Infants  Only 


Sixteen 
Per  Cent 
Cream 


Measuring 
Milk   Sugar 


102  CARE  OF  CHILDREN 

and  accurate  ways  of  measuring  the  amount  for  a 
formula  is  to  put  the  required  weighed  portion  into 
the  graduate,  tap  a  few  times,  and  mark  the  level  by 
scratching  the  glass  with  a  file.  This  mark  will  show 
the  amount  to  be  used  each  time  the  formula  is  made 
up. 

Tablespoons  vary  so  greatly  in  size  that  it  is  not  safe 
to  use  them  for  measuring  the  sugar.  Two  and  one- 
half  large  size  tablespoons  leveled  with  a  knife  will 
measure  about  an  ounce;  but  if  an  ordinary  kitchen 
tablespoon  is  used,  it  may  take  three  and  one-half 
leveled  to  give  an  ounce.  As  the  milk  sugar  is  the 
largest  constituent  of  the  baby's  food,  it  is  necessary 
that  it  be  measured  accurately. 

Milk  sugar  is  used  because  it  is  more  easily  digested 
than  cane  sugar,  and  is  not  so  liable  to  fermentation. 
Although  only  about  one-half  as  sweet  to  the  taste, 
it  has  about  the  same  nutritive  value  as  cane  sugar. 
In  the  later  months  of  the  first  year  cane  sugar  may 
be  substituted  for  milk  sugar,  if  economy  demands  it, 
a  smaller  amount  being  used. 

Salt  is  added  to  promote  digestion  and  to  make  up 
the  deficiency  occasioned  by  dilution. 
Milk  Milk  containing  4  per  cent  of  fat  should  be  used 
Anaiized  in  the  formulae  given.  A  good  milk  will  have  this 
amount,  but  the  legal  standard  in  many  localities  is 
3  per  cent  or  less,  so  that  it  is  best  to  have  the  milk 
supply  analyzed  occasionally.  The  board  of  health 
or  the  milk  commission  in  many  cities  will  make  an- 


MODIFIED  MILK 


103 


alyses  free,  and  in  the  country  the  dairies  will  per- 
form the  same  service  for  a  small  charge.  If  there  is 
4  per  cent  of  fats  present,  it  is  safe  to  conclude  that 
the  proteids  are  up  to  standard. 

For  making  up  a  formula  the  following  directions 
may  not  be  amiss:  As  soon  as  the  baby's  special 
bottle  of  milk  is  delivered  to  the  house,  it  should 
be  taken  in  and  placed  in  the  coldest  part  of  the  re- 
frigerator. If  it  is  delivered  very  early  in  the  morn- 
ing (during  hot  weather),  a  small  ice  box  should  be 
provided  in  which  the  milkman  may  place  the  bottle. 

In  the  country,  if  the  milk  is  received  while  warm, 
it  should  be  strained  through  absorbent  cotton  or 
cheesecloth  into  a  clean  quart  milk  bottle  or  preserve 
jar,  stoppered,  and  placed  in  cold  running  water  for 
about  half  an  hour,  and  then  put  on  ice  for  six  hours, 
or  until  the  cream  has  risen. 

It  will  be  found  convenient  to  keep  the  vessels,  lime 
water,  milk  sugar,  etc.,  together  on  a  tray.  The  one 
to  do  the  mixing  should  wash  her  hands  carefully  and 
put  on  a  clean  apron.  The  mixing  should  be  done  in 
a  clean  place.  A  copy  of  the  formula  to  be  made 
up  should  be  at  hand. 

To  siphon  off  the  milk,  a  glass  tube  should  be  used, 
as  shown  in  the  illustration.*  To  start  the  siphon,  fill 
it  full  of  boiling  wa*er  by  pouring  water  in,  place  the 
thumb  over  the  end  of  the  long  arm  and  invert  the 
siphon,  lowering  the  short  arm  gently  to  the  bottom  of 
the  bottle  of  milk.  Remove  the  thumb  and  the  milk  will 


Directions 
for  Mixing 


Siphoning 
Off  the 
Skimmed 
Milk 


*  A  milk  syphon  may  be  obtained  through  the  school  for  25  cents. 


104  CARE  OF  CHILDREN 

follow  the  water  out  of  the  tube.  It  is  best  caught 
in  another  bottle  or  a  32-ounce  graduate.  A  mark  on 
the  receiving  bottle  showing  when  26  ounces  have  been 
drawn  will  leave  the  6  ounces  of  16  per  cent  cream 
in  the  first  bottle,  provided  the  bottles  are  full  quarts 
of  32  ounces.  If  the  milk  is  very  rich  in  cream,  less 
than  26  ounces  of  skimmed  milk  should  be  removed. 
Making  Suppose  Formula  4  is  to  be  made  up — the  6  oz.  of 
Formal*  16  per  cent  cream  is  first  mixed  to  a  uniform  consist- 
ency by  rotating  the  bottle  gently ;  exactly  4  oz.  is 
measured  in  the  graduate  and  poured  into  the  mixing 
pitcher.  Two  ounces  of  the  skimmed  milk  is  then 
very  carefully  measured  in  the  graduate  and  poured 
into  the  pitcher.  Two  ounces  of  lime  water  is  now 
measured  and  added  to  the  pitcher;  the  1J/2  oz.  of 
milk  sugar  is  measured  in  the  8  oz.  graduate  as  de- 
scribed, and  the  two  pinches  of  salt  added.  Boiled  water 
is  added  up  to  the  8  oz.  mark.  The  mixture  is  stirred 
with  a  clean  spoon  kept  for  the  purpose  until  the 
sugar  is  dissolved  and  added  to  the  pitcher.  Sixteen 
ounces  of  water  (making  24  oz.  in  all)  is  measured 
and  added  to  the  pitcher  and  the  whole  is  stirred  with 
the  spoon  until  thoroughly  mixed. 

If  wide-mouthed  tubes  are  used,  they  may  be  filled 
by  pouring  directly  from  the  pitcher  up  to  the  2  oz., 
2}4  oz.  or  3  oz.  marks  on  the  tubes,  according  to  the 
amount  to  be  given  at  a  feeding.  If  small-mouthed 
tubes  are  used,  a  glass  funnel  will  be  necessary.  The 
tubes  are  stoppered  at  once  with  sterilized,  non-absor- 


MODIFIED  MILK 


105 


bent  cotton,  which  is  kept  in  some  receptacle  away 
from  the  dust.  After  stoppering  the  tubes  are  placed 
in  a  rack  and  put  in  the  coldest  part  of  the  refrigera- 
tor.    The  whole  operation  should  be  accomplished  as 


Keep  the 

Milk 

Cool 


SIPHONING  SKIMMED  MILK  FROM  THE  CREAM. 

If  there  is  a  difference  in  level  of  about  4}4  inches  between  the  two  milk 

bottles,  the  siphon  will  stop  running  with  approximately  6 

oz.  of  cream  left  in  the  upper  bottle,  and  26  oz.  of 

skimmed  milk  in  the  receiving  bottle. 

quickly  as  possible,  so  that  the  milk  will  not  have 
time  to  become  warm.  It  should  be  borne  in  mind 
that  there  is  always  dust  laden  with  bacteria  in  the  air 
of  the  cleanest  room.  The  bacteria  we  are  endeavor- 
ing to  exclude. 

All  the  utensils  used  should  now  be  rinsed  first  in 
cold  water,  then  washed  in  hot  soap  and  water,  put 


Washing 

Vessels 


io6 


CARE  OF  CHILDREN 


Change 

From  One 

Formula 

V>  the  Next 


into  a  pan  of  boiling  water  for  10  or  15  minutes,  and 
then  inverted.  They  should  not  be  wiped  with  a 
towel,  and  if  washed  perfectly  clean  with  plenty  of 
soap  will  drain  clear.  The  tray  should  be  washed, 
and  after  the  utensils  are  drained,  they  should  be 
placed  on  the  tray  and  covered  with  a  cloth  to  keep 
out  dust.    The  milk  sugar  should  be  kept  stoppered. 

It  is  apparent  that  an  ignorant,  untrained  servant 
cannot  be  trusted  to  carry  out  all  these  precautions, 
and  that  the  mixing  should  be  done  by  the  mother  or 
trained  nurse. 

The  importance  of  increasing  the  strength  as  well 
as  the  quantity  of  the  food  gradually  should  again  be 
emphasized.  In  changing  from  one  formula  to  the 
next  stronger,  the  simplest  method  of  making  the 
transition  a  gradual  one  is  to  add  water  to  the  new 
formula  in  such  proportion  as  to  reduce  the  percent- 
age of  proteid  to  nearly  that  of  the  preceding  formula. 
The  following  may  serve  as  a  suggestive  guide: 


In  changing  from  Formula  2  to  Formula  3,  add  to  the  full 
quantity  of  formula  3,  the  first  day  5  oz.  of  water,  second  day 
4  oz.,  third  day  2  oz.,  fourth  day  I  oz. 

Changing  from  Formula  3  to  Formula  4,  add  6  oz.  of  water 
the  first  day,  4  oz.  the  second  day,  2  oz.  the  third  day. 

Changing  from  Formula  4  to  Formula  5,  add  5  oz.  of  water 
the  first  day,  4  oz.  the  second,  3  oz.  the  third,  2  oz.  the  fourth, 
and  1  oz.  the  fifth. 

Changing  from  Formula  5  to  Formula  6,  add  8  oz.  the  first 
day,  and  1  oz.  less  during  succeeding  days. 


MODIFIED  MILK  107 

Changing  from  Formula  6  to  Formula  7,  add  7  oz.  of  water 
the  first  day,  and  1  oz.  less  every  two  days. 

Changing  from  Formula  7  to  Formula  8,  add  2x/2  oz.  of 
water  the  first  day,  2  oz.  the  second  day,  1  oz.  the  third  and 
fourth  days. 

Changing  from  Formula  8  to  Formula  9,  add  10  oz.  of 
water  the  first  day,  and  1  oz.  less  during  succeeding  days. 

Changing  from  Formula  9  to  Formula  10,  add  10  oz.  of 
water  the  first  day  and  1  oz.  less  during  succeeding  days. 

Changing  from  Formula  10  to  Formula  11,  add  9  oz.  of 
water  the  first  day  and  1  oz.  less  during  succeeding  days. 

Changing  from  Formula  11  to  Formula  12,  add  5  oz.  of 
water  the  first  day  and  1  oz.  less  during  succeeding  days 

Changing  from  Formula  12  to  Formula  13,  add  8  oz.  of 
water  the  first  day  and  1  oz.  less  during  each  succeeding  day. 

In  case  the  new  formula  does  not  seem  to  agree,  the 
number  of  ounces  of  water  added  should  be  reduced 
more  slowly.  Carefully  written  notes  should  be  kept 
of  all  changes. 

Cream  containing  16  per  cent  of  fat  also  contains 
a  certain  percentage  of  proteids  and  milk  sugar. 
Roach  gives  the  following  composition : 

Composition  of  16  Per  Cent    Cream 

Per  Cent 

Water    76.7 

Proteids     3.2 

Fats    16.0 

Milk  Sugar   4.05 

Composition     of    Skimmed    Milk 

Per  Cent 

Water    92  7 

Proteids     3.6 

Fats trace 

Milk  Sugar  4.6 


Keep 
Notes 


108  CARE  OF  CHILDREN 

use  of  Where  proteids  are  not  tolerated  whey  (see  recipe) 
may  be  substituted  for  the  skimmed  milk  and  for  the 
whole  or  part  of  the  boiled  water. 

The  whey  contains  the  lac  albumen  (but  no  casein), 
the  sugar  and  the  salts  of  the  milk.  The  Walker- 
Gordon  Co.  gives  the  following  analysis  for  the  whey 
which  they  furnish.  It  is  made  from  skimmed  milk 
and  contains  practically  no  fat. 

Composition  of  Whey 

Per  Cent. 

Water    93.6 

Proteids    1.0 

Milk   Sugar    4.7 

Mineral  Matter   0.7 

Egg         If  the  intolerance  for  milk  proteids  persists,  the  pro- 

Albumon 

teid  of  egg  white  (see  recipe)  may  be  substituted. 
The  white  of  one  egg  has  the  proteid  value  of  eight 
ounces  of  skimmed  milk. 

Composition  of  White  of  Egg 

Per  Cent. 

Water    85.7 

Proteids    12.6 

Fats      0.25 

Mineral  Matter 0.59 


FOODS   OTHER    THAN   MILK  109 

FOODS   OTHER    THAN   MILK 

Other  foods  than  milk  may  be  utilized,  to  a  limited 
extent,  in  the  dietary  of  the  infant.  Of  these  there 
are  three  general  classes. 

First :    Farinaceous  substances ;  such  as  barley,  oat-     starch 
meal,  arrowroot,  farina,  rice,  wheat  and  bread,  pref- 
erably in  the  form  of  water  gruels,  and  jellies. 

Second:  Albuminoids  or  proteids,  of  which  class 
beef  juice  and  egg  white  are  the  best  representatives. 

Third:     Fruit  juices,  as  orange,  prune  and  unfer-     Fruit 

,     ,  Juices 

mented  grape. 

The  first  class  have,  before  the  sixth  month  of  in- 
fancy, but  a  limited  food  value,  because  of  the  indi- 
gestibility  of  their  starchy  contents.  A  partial  con- 
version into  sugar  may  be  secured,  however,  by  thor- 
ough and  prolonged  cooking,  as  in  the  preparation  of 
gruels  and  jellies.  A  still  further  conversion  may 
be  secured  by  the  addition  of  diatase,  as  malt  and 
malt  extracts,  a  few  minutes  before  feeding.  This 
changes  a  certain  amount  of  the  starch  into  dextrin. 

Cereal  gruels,  in  some  cases,  promote  digestion  of      oiueis 
cow's  milk  by  mechanically  preventing  the  formation 
of  dense  curds  in  the  stomach.    They  may  be  used  to 
replace  all  or  a  part  of  the  water  of  a  formula. 

When  the  proteid  of  cow's  milk  is  not  well  borne 
that  most  essential  constituent  may  be  supplied  from 
raw  beef  juice  or  egg  white.     (See  recipes.) 

Orange  juice,  prune  juice  and  unfermented  grape 
juice  are  very  valuable  food  adjuncts  in  cases  of  nutri- 


no 


.CARE  OF  CHILDREN 


Patent 
Baby 
Foods 


tional  depravity.  These  are  especially  needed  where 
the  infant  has  been  subject  to  the  prolonged  use  of 
cooked  and  pasteurized  foods. 

Many  of  the  so-called  baby  foods  contain  little  more 
than  starch,  and  on  that  account  can  not  be  too 
severely  condemned  for  young  children ;  but  the  prac- 
tice, somewhat  in  vogue,  of  denouncing  all  patent 
foods  on  that  account  is  thoughtless  and  unjust.  There 

Percentage  Composition  of  Infant  Foods 


Food           ,  Moisture 

Proteids 

Fat 

Carbo-    |  Mineral 
hydrates  |    Matter 

Remarks 

Horlick's 

Malted 
Milk 

3.9 

13  8 

3.0 

76.8 

2.7 

A  mixture  of  desic- 
cated milk  (50s0  and 
malted  wheat  and  bar- 
ley. No  unaltered 
starch. 

Mellin's 
Food* 

5.7 

10.7 

0.1 

79.1 

4.4 

A  completely  malt- 
ed food.  All  the  carbo- 
hydrates in  soluble 
form. 

Nestle's 
Food* 

3.6 

14.0 

5.2 

75.1 

1.9 

A  mixture  of  desic- 
cated milk,  partially 
malted  wheat  flour 
and  cane  sugar  (27%). 
Starch  15%. 

Eskay's 
Food* 

1.7 

6.7 

3.5 

87.1 

1.0 

A  mixture  of  par- 
tially malted  wheat, 
egg  albumin  and  milk 
sugar  (54«f).  Starch 
2956,  especially  treated. 

Condensed 
Milk 

62.0 

9.1 

10.7 

15.5  . 

4.3 

Unsweetened  whole 
cow's  milk.  1  part  di- 
luted with  2  parts  wa- 
ter gives  ordinary 
milk.  Sweetened  con- 
densed milk  contains 
about  37?t  cane  sugar. 

Dried 
Human 

Milk 



12.2 

26.4 

52.4 

2.1 

Analysis  by 
Hutchison 

*  Latest  analyses,  given  by  the  manufacturers. 


MEDICAL  SUPERVISION 


in 


is  much  to  recommend  in  some  of  these  preparations, 
since  intelligent  modification  by  supplying  a  deficiency, 
may  convert  it  into  a  most  valuable  adjunct  in  sub- 
stitute feeding.  Food  which  would  not  meet  the  re- 
quirements of  nutrition  for  a  long-continued  period, 
because  deficient  in  some  essential  constituent,  may 
be  used  temporarily,  as  in  weaning,  traveling  or  tem- 
porary removal  from  the  breast. 

Among  the  objections  to  many  of  the  patent  foods 
may  be  mentioned :  small  amount  of  fats ;  insolu- 
bility of  their  proteids  when  present ;  excess  of  sugar, 
especially  cane  sugar;  the  high  percentage  of  uncon- 
verted starch  and  the  fact  that  all  have  been  cooked. 

The  writer  believes  that  the  artificially  fed  infant 
should  always  be  under  the  supervision  of  a  competent 
physician.  Some  one  has  said  that  it  is  twice  as  dan- 
gerous to  be  a  baby  as  it  is  to  have  smallpox.  The 
mortality  in  untreated  typhoid  is  less  than  half  that 
of  artificially  fed  babies,  yet  no  one  questions  the 
necessity  for  a  physician  in  typhoid.  Few  regard  the 
physician  as  out  of  place  at  the  birth  of  the  infant, 
yet  the  mortality  during  birth  is  slight  compared  with 
that  of  bottle  feeding.  The  most  active  function  of  a 
physician's  life  is  remedying  errors,  in  attempting  to 
patch  up  the  evil  results  of  mistakes.  His  highest 
function  is  to  ward  off  the  error  and  to  prevent  the 
mistakes. 

The  infant  at  the  breast  is  in  normal  relation  with 
his  most  imperative  need  and  is  seldom  under  the 
physician's   care.     He  who   substitutes   artificial   for 


Medical 
Supervision 
in  Artificial 
Feeding 


Bottle  Fed 
Babies  not 
in  Normal 
Condition 


112 


CARE  OF  CHILDREN 


No  Perfect 

Substitute 

Food 


Province 
of  the 
Mother 


natural  feeding  unnecessarily  may  be  likened  to  the 
captain  who,  in  a  safe  roadstead,  slips  his  cable  in 
the  face  of  a  gale  and  trusts  his  vessel  to  unknown 
waters  without  pilot,  chart  or  compass. 

No  method  yet  devised  can  take  the  place  of  breast 
feeding.  No  substance  nor  combination  has  been  dis- 
covered that  meets  all  the  requirements  of  the  infant 
as  does  breast  milk. 

The  vast  amount  of  study  and  research  of  the  best 
minds  have  evolved  as  yet  towards  the  solution  of  this 
question  only  a  few  scientific  principles.  The  appli- 
cation of  these  to  individual  cases  calls  for  the  best 
work  of  the  trained  physician. 

As  before  said,  the  most  available  artificial  food  for 
babies,  cow's  milk,  can  not  be  made  to  resemble  that 
of  the  mother,  and  in  many  instances  man's  highest 
skill  can  not  adapt  it  to  the  requirements  of  the  infant, 
though  he  modify  it  ever  so  wisely.  How  difficult, 
then,  the  task  of  writing  formulae  for  the  modifica- 
tion of  an  indefinite  substance  (milk)  for  the  feeding 
of  unknown  infants,  whose  unknown  requirements 
are  the  result  of  unknown  conditions. 

The  supervision  of  the  physician  does  not  lessen  the 
care  required  of  the  mpther  or  nurse,  nor  make  it  less 
necessary  that  she  should  understand  the  situation. 
However  wise  the  advice  may  be,  trouble  is  almost 
sure  to  follow  unless  the  rules  and  precautions  given 
are  followed  to  the  letter. 


FOOD    DISORDERS 


ii3 


FOOD   DISORDERS 

Overfeeding  is  responsible  for  many  of  the  diges-  overfeeding 
tive  disturbances  of  infancy.  Among  the  causes  of 
overfeeding  may  be  mentioned  irregularity  as  to  time ; 
thirst ;  perverted  taste ;  improperly  balanced  or  too 
concentrated  a  food;  too  rapid  feeding,  and  general 
ignorance  or  carelessness  on  the  part  of  the  nurse. 
The  usual  result  of  occasional  overfeeding  is  acute 
indigestion,  with  or  without  vomiting,  belching,  colic, 
diarrhoea,  curds  in  stool,  restlessness,  broken  sleep, 
fever  or  loss  of  weight. 

Habitual  overfeeding  may  cause  dilatation  of  the 
stomach  with  loss  of  digestive  power  and  all  the  symp- 
toms of  chronic  dyspepsia,  such  as  flatulence,  colic, 
constipation  or  diarrhoea,  loss  of  weight  or  general 
mal-nutrition. 

Occasional  colic  or  loose  stools  or  even  vomiting  colic 
may  call  for  nothing  more  than  a  temporary  diminu- 
tion of  food  and  a  dose  of  castor  oil.  In  mild  cases, 
the  food  may  be  diluted  with  about  a  fourth  the  vol- 
ume of  water,  either  in  the  nursing  bottle  before  feed- 
ing or  when  the  day's  supply  is  made  up.  The  quan- 
tity given  may  also  be  reduced  somewhat.  In  return- 
ing to  the  original  formulae  the  change  should  always 
be  made  gradually. 

Persistent  colic  may  be  an  indication  of  excessive 
proteids,  the  percentage  of  which  should  be  reduced 
to  the  relief  of  both  colic  and  diarrhoea,  with  the  dis- 
appearance of  curds  from  the  stools. 

Vomiting,  or  "spitting  up,"  with  or  without  diar-     vomitur 


114 


CARE  OF  CHILDREN 


Hot 

Weather 
Diet 


rhoea,  may  be  caused  by  an  excess  of  fat  and  yield 
promptly  to  a  reduction  of  this  constituent.  If  food 
is  not  digested  fermentation  occurs  in  the  bowels,  with 
the  formation  of  poisons,  which  cause  restlessness  and 
fever.  This  "auto-intoxication"  is  of  frequent  occur- 
rence in  infancy,  but  is  usually  relieved  by  the  cor- 
rection of  the  dietetic  errors. 

A  common  mistake  is  the  neglect  to  modify  the 
food  with  due  regard  to  the  season.  Hot  weather  re- 
quires diminution  in  the  fats  and  proteids  (from  one- 
eighth  to  one-half),  so  that  what  constituted  a  well- 
balanced  food  for  the  winter  months  is  not  suitable 
for  the  heated  term.  In  hot  weather  infants  need 
more  water  and  frequently  cry  from  thirst  rather  than 
hunger. 

The  long-continued  use  of  food  deficient  i  n  fat 
is  often  productive  of  rickets.  Scurvy  may  be  de- 
veloped by  the  habitual  use  of  cooked  food,  while 
mal-nutrition  is  the  result  of  chronic  indigestion. 

The  prevention  and  correction  of  these  disorders 
lies  in  proper  feeding  (See  "Essentials.")  Their 
symptoms  will  be  discussed. in  the  section  on  Chil- 
dren's Ailments. 

The  practice  of  experimenting  on  the  baby  with  all 
kinds  of  food — patent  and  otherwise — is  a  most  per- 
nicious one.  Nature  takes  some  time  to  rectify  diges- 
tive disturbances,  and  a  slight  improvement  at  each 
feeding  is  all  that  can  be  expected.  If  the  simple 
changes  suggested  do  not  give  relief  after  a  day  or 
two,  the  physician  should  be  consulted. 


FOOD  AFTER  THE  FIRST  YEAR 


Bottle  feeding  is  rarely  necessary  after  the  twelfth 
month.  The  child  may  be  gradually  taught  to  drink 
from  a  spoon  or  cup.  Where  the  baby  is  delicate  the 
bottle  may  be  used  until  the  fifteenth  month. 

The  eruption  of  teeth,  the  increase  in  the  salivary, 
gastric  and  pancreatic  secretions  give  not  only  greater 
power  of  starch  and  proteid  digestion,  but  also  the 
ability  to  masticate  some  solid  food. 

Semi-solids  must  be  introduced  gradually  into  the 
dietary,  milk  remaining  the  principal  food.  Cream 
is  required  particularly  where  there  is  a  tendency  to 
constipation.  Until  the  eighteenth  month  little 
change  should  be  made  except  the  addition  of  gruels, 
meat  broths  and  cracker  or  stale  bread  soaked  in  milk. 
Five  feedings  in  the  24  hours  during  the  second  year 
are  sufficient  for  a  healthy  child. 

The  following  dietary  is  intended  only  as  a  sugges- 
tive guide.  Variety  at  this  age  is  not  necessary,  but  a 
choice  is  designated  by  the  letters  a,  b,  c. 

Dietary  from  12  to  18  Months 
First  Meal.    6  to  7  A.  M. 

a — Glass  of  warm  milk  containing  a  little  stale  bread  or 
rolled  cracker. 

b — A  porridge  of  well  cooked  (at  least  two  hours)  cereal 
with  milk. 

c — A  little  soft  egg  (poached  or  boiled)  with  stale  bread 
crumbs  and  a  glass  of  milk. 

115 


Taking 
Away  the 
Bottle 


Semi- 
Solids 


n6  CARE  OF  CHILDREN 

Second  Meal,     io  A.  M. 
Glass  of  warm  milk. 
Third  Meal,     i  to  2  P.  M. 

a — Stale  bread  soaked  in  gravy  from  the  roast  or  steak. 

Milk. 
b — Soft  egg,  a  little  zwieback,  glass  of  milk. 
c — Toast  soaked  with  beef  juice    (see  recipe),  glass  of 
milk. 

Fourth  Meal.  5  to  6  P.  M. 

Glass  of  milk  or  milk  with  cereal  jelly.    (See  recipe). 
Fifth   Meal.     (If  necessary  late  in  the  evening  or  night.) 

Glass  of  warm  milk. 

Dietary  from  the  18th  to  24th  Month. 

First  Meal.     7  A.   M. 

a — Warm  milk  with  stale  bread  or  buttered  cracker. 
b — Cereal  porridge  with  milk  and  cream. 
c — Glass  of  milk,  soft  boiled  egg  with  bread  and  butter. 
Second  Meal.    10  A.  M. 
a — Bread  and  milk. 

b — Milk  from  oyster  stew  and  cracker. 
c — Milk  toast. 
Third  Meal.     2  P.  M. 

a — Mashed  potatoes  with  dish  gravy  and  a  glass  of  milk 
b — Mutton,  beet  or  chicken  broth  thickened  with  rice  or 

barley,  bread  or  cracker  and  milk. 
c — Beef  juice  on  toast,  rice  or  tapioca  pudding.     With 
this  meal  may  be  given  a  little  well  baked  apple 
pulp  or  stewed  prune  pulp  and  juice. 
Fourth   Meal.     5  to  6   P.   M. 

Bread  and  milk,  or  bread  with  butter  and  milk. 
Milk  may  be  given  during  the  night  if  the  baby  seems 
hungry. 


FOOD  AFTER  THE  FIRST  YEAR  117 

Dietary   for   Third   Year 

First  Meal.     7  to  8  A.  M. 

a — Cereal  with  plenty  of  milk  and  cream. 

b — Soft  boiled  or  poached  egg  with  toast  and  milk. 

c — Meat  jelly  with  bread  or  cracker  and  milk. 

Second  Meal,     ii  A.  M. 

Bread  and  milk,  meat,  or  clam  broth  with  cracker. 

Third  Meal.     2  P.  M. 

a — Broiled    scraped    beef    with    buttered    baked    potato. 

Milk. 
b — White  meat  of  fish  or"  fowl,  mashed  potato  with  bread 

and  butter. 
c — A  little  finely  cut  steak  or  roast,  creamed  potato  or 

boiled  rice  and  milk. 
Light  pudding,  junket,  stewed  fruit  or  a  little  ice  cream 

may  be  added  to  the  above. 

Fourth  Meal.    6  to  7  P.  M. 

a — Bread  and  butter,  glass  of  milk. 

b — Cornmeal  mush  and  milk. 

c — Baked   apple,   graham   crackers   and  milk. 

During  this  year  the  child  should  occasionally  have      FrUit 
a  little  orange  juice,  scraped  raw  apple,  grape  pulp 
free  from  seeds,  ripe  banana  grated  fine,  ripe  peach 
or  pear. 

After  the  third  year  the  child  is  presumably  sitting     At  the 

•  Fsirnily 

at  the  family  table  and  will,  if  not  well  managed,  in-      Table 
sist  upon  having  things  not  good  for  him.    Many  sys- 
tems are  hopelessly  impaired  for  want  of  parental  tact 
and  firmness  at  this  time.    If  the  child  is  once  taught 
that  he  may  not  choose  for  himself,  he  will  gladly 


Ii8 


CARE  OF  CHILDREN 


Foods 

Not 

Advisable 


Stimulants 


accept  the  food  suitable  to  his  age  and  condition.  In 
planning  the  meals  for  a  family  containing  several 
young  children  consideration  should  certainly  be  given 
to  their  requirements. 

The  following  articles  are  best  avoided  during  early 
childhood : 

Condiments    or    highly    sea-       Cake. 

soned  food.  Hot  breads. 

Pork.  Cucumbers. 

Fried  meats.  Corn. 

All  fried  foods.  Doughnuts. 

Griddle  cakes.  Doughey  puddings. 

Cabbage.  Rich  puddings. 

Tomatoes.  Over  or  under  ripe  fruits. 

Pastry.  Raw  celery. 

Dumplings.  Turnips. 

It  goes  without  saying  that  children  should  never 
be  allowed  tea,  coffee,  beer  or  other  stimulants. 

Nuts  and  confections  should  never  be  allowed  on  an 
empty  stomach. 

General    Eules 

i — Regularity  as  to  meals  is  of  prime  importance. 
2 — Thorough  mastication  is  absolutely  essential  to 

perfect  digestion. 
3 — Rapid  eating  invariably  induces  dyspepsia. 
4 — Fluids  are  essential  to  good  digestion,  but  the 

food  should  never  be  "washed  down." 
5 — A  judicious  balance  must  always  be  maintained 

between  the  five  food  constituents,  viz. :   pro- 

teids,  fats,  sugar,  salts  and  water. 


FOOD  RECIPES 
Beef    Juice 

Salt  and  slightly  broil  small  pieces  of  thick,  lean, 
round  steak  and  while  hot  express  the  juice  with  a 
meat  press  or  a  lemon  squeezer.  The  juice  may  be 
given  cold  or  with  the  addition  of  a  little  warm  water. 
Hot  water  coagulates  the  albumin.  Made  in  this  way 
the  juice  contains  from  5  to  6  per  cent  of  coagulatable 
proteids  and  from  2  to  3  per  cent  of  "extractives" — 
nitrogenous  substances  without  nutritive  value,  but 
stimulating  to  the  digestive  organs. 

Beef  Tea 

To  I  pound  of  lean  chopped  or  minced  beef  add  1 
pint  of  cold  water.  Stir  and  let  stand  for  2  hours ; 
then  let  simmer  for  20  minutes.  Do  not  boil.  Strain 
and  when  cool  remove  all  fat.  When  ready  to  use 
warm  and  season.     Best  prepared  in  double  boiler. 

Mutton  Broth 

Over  1  pound  of  lean  meat,  cut  in  small  pieces, 
pour  1  quart  of  cold  water,  let  stand  in  cold  place  for 
3  hours,  then  cook  slowly  down  to  1  pint.  Cool,  skim 
off  fat,  and  strain. 

Veal,  chicken  or  beef  broths  may  be  made  in  the 
same  way. 

Meat  Pulp 

By  scraping  with  a  dull  knife  separate  the  meat 
pulp  from  the  fiber.  Season  pulp,  make  in  small  cake 
and  slightly  broil,  or  may  be  salted  and  eaten  raw. 

'  119 


120  CARE  OF  CHILDREN 

Whey 

Heat  i  quart  of  fresh  milk  luke  warm;  into  this 
gently  stir  2  teaspoonfuls  of  Fairchild's  essence  of 
pepsin ;  let  stand  about  twenty  minutes  or  until  firmly 
coagulated,  then  with  a  fork  break  up  the  clot  and 
strain  through  fine  muslin  without  pressure.  Bring 
the  whey  thus  obtained  to  a  boil  to  kill  the  ferment, 
then  cool  and  keep  on  ice. 

Albumin  Water 

Put  the  white  of  one  egg  in  a  saucer  and  cut  (do 
not  beat)  until  fine  with  knife  and  fork.  Add  1  cup 
cold  boiled  water  and  strain  through  cheesecloth. 
Keep  on  ice  until  ready  to  use.  If  desired  a  tiny 
pinch  of  salt  may  be  added. 

Lime  Water 

Drop  a  piece  of  unslaked  lime  as  large  as  a  walnut 
into  a  vessel  containing  2  quarts  of  pure  filtered 
water,  stir  thoroughly  and  allow  to  settle.  Pour  off 
the  clear  solution  into  bottles,  which  should  be  kept 
corked. 

Oat  Jelly 

Soak  half  a  cup  of  coarse  oatmeal  in  a  quart  of  cold 
water  for  10  hours.  Boil  down  so  as  to  make  a  pint 
and  while  hot  strain  through  fine  cheesecloth.  A 
jelly  is  formed  when  cold.  It  should  be  kept  on  ice 
until  needed. 

Wheat  and  rice  jelly  can  be  prepared  in  the  same 
way. 


FOOD  RECIPES  121 

Barley  Water 

Put  i  tablespoonful  of  washed  pearl  barley  in  a 
saucepan  with  a  quart  of  water;  boil  slowly  down  to 
1  pint ;  strain. 

Barley  Jelly 

Boil  slowly  down  to  a  pint,  1  quart  of  water  and  3 
tablespoonfuls  of  pearl  barley ;  strain  and  let  stand 
until  jellied. 

Peptonized   Milk 

In  4  ounces  of  boiled  cold  water,  dissolve  a  tablet 
containing  15  grains  of  bicarbonate  of  soda  and  5 
grains  of  pancreatine,  to  which  add  12  ounces  of  milk. 
Set  vessel  containing  this  mixture  in  a  pan  of  water 
at  a  temperature  of  H5°F  for  from  8  to  10  minutes. 
Cool  quickly  by  placing  in  running  water  and  keep  on 
ice  until  used.  Use  double  boiler  for  making.  To 
completely  peptonize  the  milk  heat  for  two  hours. 
It  then  has  a  bitter  taste. 

Dropped  Egg 

Drop  a  fresh  egg  into  enough  boiling  milk  to  cover ; 
remove  from  milk  as  soon  as  the  white  is  set;  salt 
and  serve  hot  with  cracker  or  bread  crumbs. 

Dried  Bread 

Cut  bread  at  least  24  hours  old  in  thick  slices;  put 
in  slow  oven  and  bake  until  thoroughly  dried.  (20  to 
30  min.) 


122  CARE  OF  CHILDREN 

Kumyss — (Holt) 

I  quart  of  fresh  milk,  half  an  ounce  of  sugar,  2 
ounces  of  water,  a  piece  of  yeast  cake  at  least  half 
an  inch  square ;  put  into  wired  bottles,  keep  at  a  tem- 
perature between  60  and  70  F.  for  1  week,  shaking 
5  or  6  times  a  day ;  put  on  ice. 


CARE  OF  CHILDREN 

PART  II 

Read  Carefully.  Place  your  name  and  address  on  the 
first  sheet  of  the  test.  Use  a  light  grade  of  paper  and  write 
on  one  side  of  the  sheet  only.  Iyeave  space  between  the 
answers  for  the  notes  of  the  instructor.  Use  your  own 
words  and  answer  fully.  Read  the  lesson  paper  a  number 
of  times  before  attempting  to  answer  the  questions. 

1.  What  is  the  best  food  for  the  baby  and  why? 

2.  What  is  the  effect  upon  the  child  of  too  much 

fat  in  the  milk?    Too  little? 

3.  What  are  the  indications  for  early  weaning? 

4.  Why  should  the  baby  not  nurse  the  breast  of  a 

sleeping  mother? 

5.  Give  and  explain  four  rules  for  nursing. 

6.  Give  in  detail  the  difference  between  mother's 

and  cow's  milk. 

7.  What  may  be  done  to  increase  the  percentage 

of  fat  in  breast  milk?     The  percentage  of 
proteid  ? 

8.  Give    some    of    the  causes  of  impairment    of 

mother's  milk. 

9.  How  should  the  baby  be  weaned? 

10.  When  the  proteids  of  cow's  milk  are  not  toler- 

ated, what  may  be  substituted  for  them? 

11.  Why   give   a   baby   water?      When?      How? 

How  much? 


CARE  OF  CHILDREN 

12.  State   general    objections    to   the   patent   baby- 

foods. 

13.  What  is   safe  milk?     How   should  the  baby's 

milk  be  cared  for  in  the  home? 

14.  What   governs  the  quantity  given  at  a   feed- 

ing?   The  strength  of  the  food? 

15.  Give  the  causes  and  effects  of  over  feeding. 

16.  What  are  the  principal  dangers  in  feeding  a 

baby  cow's  milk? 

17.  What  is  meant  by  a  balanced  food? 

18.  Why  are  special  precautions  necessary  to  keep 
•     the  baby's  food  as  nearly  sterile  as  possible? 

19.  What  can  you  say  in  regard  to  feeding  during 

the  second-  year  ? 

20.  How  would  you  alter  the  food  of  a  young  baby 

in  very  hot  weather? 

21.  What  may  the  mother  or  nurse  safely  do  if 

the  baby  has  indigestion? 

22.  Mention  new  facts  you  have  learned  from  this 

lesson. 

23.  What  questions  have  you  to  ask? 

Note. — After  completing  the  test,  sign  your  full  name. 


CARE  OF  CHILDREN 

PART  III 


iHllllRtN  INOER  I  Yr. 

14  Yr. 

2-5  Yr. 

5-15  Yr. 

OVER  15  Yrs. 

CHART  SHOWING  MORTALITY  IN  LARGE  CITIES  BY  MONTHS 
AND  AGES 
From  Circular  of  Illinois  State  Board  of  Health  on  Infant  Feeding 


CARE  OF  CHILDREN 

PART  111 

The  Sick  Child 


SYMPTOMS  OF  DISEASE 
The  sick  child  should,  of  course,  always  be  under 
the  physician's  care,  but  the  mother  can  aid  greatly 
by  giving  him  an  intelligent  account  of  symptoms.  The 
mother  knows  (or  should  know)  her  child  much  more 
thoroughly  than  can  any  outsider  and  it  is  on  her 
carrying  out  of  directions  faithfully  and  intelligently 
that  the  recovery  of  the  sick  child  must  depend. 

In  order  to  recognize  the  symptoms  of  disease  it  is      symptoms 

1  i  i      r       -1-  -ii  ta   Health 

necessary  to  become  thoroughly  familiar  with  the  nor- 
mal, healthy  infant.  This  is  accomplished  only  by 
careful,  conscious  observation.  Attitude,  both  sleep- 
ing and  waking;  facial  expression,  movements  of  ex- 
tremities, trunk,  head  and  eyes;  sounds,  both  articu- 
late and  inarticulate ;  respiration,  frequency  and  regu- 
larity; color  of  the  skin  and  condition  as  to  tempera- 
ture and  moisture,  are  all  significant  of  sickness  or 
health. 

Restlessness  or  apathy,  if  but  slight,  may  be  esti- 
mated only  by  comparison  with  the  baby's  normal  con- 
dition. 

A  few  of  the  most  easily  recognized  indications  of 
acute  disorder  may  be  mentioned,  such  as  sudden  loss 
of  appetite,  excessive  thirst,  unusual  drowsiness,  lan- 
guor or  fretfulness,  all  of  which  may  indicate  intoxi- 
cation. 

123 


124 


CARE  OF  CHILDREN 


Breathing 


Fever 


The  screaming  infant  may  give  some  hint  as  to 
the  location  of  his  pain  by  chewing  his  fingers  when 
the  mouth  or  throat  is  inflamed ;  by  carrying  his  hand 
to  his  head  or  pulling  at  his  hair  when  the  ear  or 
mastoid  region  is  the  seat  of  trouble ;  by  writhing  mo- 
tions of  the  body  with  drawing  up  of  the  knees  which 
indicates  abdominal  pain,  whether  of  the  stomach  or 
bowels  or  bladder. 

The  rapid  breathing  may  indicate  pulmonary  dis- 
order ;  the  terminal  expiratory  moan,  pneumonia ;  or 
the  restricted,  expiratory  grunt  may  mean  an  abdomi- 
nal pain  or  pleurisy,  the  short  suppressed  cough  end- 
ing in  a  cry  may  indicate  pneumonia  or  pleurisy. 

Headache  is  often  indicated  by  puckering  of  the 
eyebrows  and  intolerance  of  strong  light,  while  throw- 
ing the  head  back  with  rigidty  of  the  neck  or  continu- 
ous head  rocking  are  common  symptoms  of  meningitis 
or  brain  fever.  Twitching  of  the  face  or  of  the  ex- 
tremities may  be  the  precursor  of  convulsions. 

The  flushed  face  of  fever  is  too  obvious  to  be  over- 
looked and  the  whiteness  about  the  lips  and  nose  is 
always  indicative  of  nausea  or  irritation  of  the  intesti- 
nal tract,  whether  from  indigestion  or  worms,  and 
usually  precedes  vomiting. 

Crying  when  handled  usually  indicates  some  local 
tenderness  in  trunk  or  limbs  and  may  be  due  to  in- 
juries, such  as  dislocations,  fractures  or  contusions; 
or  to  the  tenderness  of  rickets,  scurvy,  syphilis,  rheu- 
matism or  inflammation  of  some  joint.    Copious  sweat- 


THE  CRY 


125 


ing  during  sleep,  especially  about  the  head,  is  always 
suggestive  of  rachitic  malnutrition.  Disinclination  or 
inability  to  move  a  limb  should  never  be  overlooked 
as  it  may  mean  a  grave  disorder,  either  in  the  affected 
limb  or  in  the  central  nervous  system.  Refusal  to 
nurse  may  be  due  to  trouble  in  the  mouth,  throat  or 
nose  which  parts  should  be  frequently  examined. 


THE  CRY 

There  is  no  such  thing  as  a  meaningless  cry.  It  is 
only  a  question  of  interpretation.  The  cry  is  the  in- 
fant's only  means  of  making  his  wants  known. 

Most  welcome  is  the  baby's  first  cry  induced  by  the 
discomfort  of  his  new  surroundings  and  its  vigor  and 
volume  may  indicate  vital  capacity.  A  little  lusty  cry- 
ing in  the  first  days  is  good  for  the  baby  as  thereby 
deep  inspiration  is  induced  which  more  fully  inflates 
the  lungs  and  establishes  more  completely  the  new 
function  of  respiration.  Some  babies  never  entirely 
overcome  the  adhesions  of  the  bronchial  tubes  and  air 
cells,  a  part  of  the  lung  remaining  unused. 

The  cry  should  be  clear  and  distinct  and  any  devi- 
ation from  its  normal  tone  is  an  indication  of  disorder. 
Whatever  the  cause  of  crying  it  is  usually  tearless  be- 
fore the  third  month. 

Hunger  is  usually  expressed  by  crying,  but  it  is  a 
great  mistake  to  conclude  that  because  the  child  was 
quieted  by  the  nipple  he  was  therefore  hungry.  He 
may  have  been  thirsty,  or  the  warm  milk  may  have 


No 

Meaningless 

Crying 


Hungry 
Cry 


126 


CARE  OF  CHILDREN 


Persistent 
Crying 


"Whining 


temporarily  relieved  the  pain  due  to  indigestion.  In 
either  case  the  food  will  harm  him.  Water  was  what 
he  needed. 

Most  often  a  baby  cries  because  he  is  uncomforable 
— the  diaper  may  need  to  be  changed ;  the  clothes  may 
need  straightening  out,  he  may  need  a  change  of  posi- 
tion, or  he  may  be  cold.  There  is  such  a  thing,  too, 
as  the  crying  habit,  which  over-anxious  mothers  help 
to  establish  by  holding  the  baby,  rocking,  singing, 
walking,  coddling  or  nursing  at  the  first  intimation  of 
restlessness,  however  transient  if  left  alone. 

A  persistent  cry,  if  not  due  to  hunger  or  thirst,  is 
indicative  of  pain,  as  from  pin  prick,  itching  from 
bites,  eruption,  eczema.  Earache  causes  intense  pain. 
Paroxysmal  crying  may  mean  colic  or  bowel  cramps, 
and  ceases  when  the  gas  moves.  Usually  with  this 
pain  the  feet  are  drawn  up  and  the  belly  is  distended. 
Pleurisy  or  tenderness  of  rickets  causes  baby  to  cry 
when  lifted  by  the  arms  or  chest.  Tenderness  about 
legs  would  suggest  rheumatism  or  scurvy. 

Peevish  whining  indicates  poor  health  and  general 
discomfort.  Brain  inflammation  is  often  indicated  by 
a  shrill  piercing  shriek  uttered  at  long  intervals. 
Short  suppressed  cry  occurs  in  lung  inflammation,  es- 
pecially following  coughing.  Sudden  screaming  at 
night  suggests  night  terrors  or  bad  dreams.  Hoarse 
croupy  voice  points  to  the  larynx,  and  a  nasal  tone 
to  stoppage  of  nose  and  upper  throat.  Mouth  dis- 
orders cause  fretfulness  and  crying  when  anything  is 


COLIC 


127 


put  into  the  mouth,  while  cry  after  swallowing  sug- 
gests sore  throat. 

The  baby  may  cry  when  passing  urine  due  to  tight 
foreskin  or  the  passage  of  brown  uric  acid  sand,  which 
may  be  found  staining  the  diaper.  If  the  child  frowns 
while  crying  or  fretting  and  avoids  the  strong  light, 
headache  is  probably  the  cause. 

COLIC 

Colic  is  usually  due  to  the  pressure  of  gas  in  the 
bowels,  one  of  the  results  of  indigestion.  Sudden  and 
violent  crying,  distended  abdomen,  alternate  drawing 
up  and  straightening  of  the  legs,  which  ceases  with 
the  expulsion  of  gas  by  mouth  or  anus,  usually  indi- 
cate colic.  This  colic  is  often  due  to  too  frequent  or 
too  copious  feeding,  hence  the  great  mistake  in  quiet- 
ing the  cries  of  the  colicky  baby  by  more  feeding. 
Some  babies  are  especially  prone  to  colic  and  must  be 
fed  with  extreme  care. 

Again  babies  are  colicky  while  showing  no  other 
evidence  of  dietetic  error.  In  these  cases  the  attacks 
may  be  due  to  chilling  of  the  surface  of  extremities. 
Great  care,  therefore,  is  necessary  in  maintaining 
proper  warmth  by  suitable  clothing,  especially  of  the 
hands  and  feet.     (See  baby  bag,  page  22.) 

Another  form  of  colic  is  caused,  as  before  men- 
tioned, by  sharp  uric  acid  crystals  in  the  kidneys  and 
urinary  tubes. 

Simply  changing  the  position,  as  holding  the  baby 
over  the  shoulder,  is  often  effective  in  expelling  the 


Causes 


Uric    Acid 
Colio 


128  CARE  OF  CHILDREN 

Treatment  gas.  Gentle  massage  of  the  abdomen  is  helpful.  Hot 
carminative  teas,  as  peppermint,  anise,  camomile  and 
catnip,  with  a  grain  or  two  of  bicarbonate  of  sodium, 
may  relieve  the  pain,  or  in  case  of  exhaustion  as  in- 
dicated by  cold  or  blueness,  2  or  3  drops  of  brandy 
in  a  little  water  sweetened  with  milk  sugar  may  be 
added.  Dry  heat  applied  to  the  extremities  and  abdo- 
men by  means  of  hot  flannel  or  water  bag  with  gentle 


RUBBER  CATHATER. 


massage  of  the  abdomen  will  assist.  A  warm  high 
enema  or  a  rubber  tube  (see  Medicine  Chest)  intro- 
duced and  left  in  the  bowel  for  a  few  seconds  may 
promote  the  expulsion  of  the  gas.  Where  colic  is  per- 
sistent or  of  frequent  occurrence  the  physician  should 
be  consulted  with  regard  to  a  change  in  the  diet. 

CONSTIPATION 

Constipation  is  so  common  during  infancy  that  some 
physicians  have  regarded  it  as  normal  to  that  period 
of  life.  While  not  agreeing  with  that  opinion,  it  is 
apparent   that   certain    anatomical    and    physiological 


CONSTIPATION  129 

peculiarities  of  the  infant's  intestinal  tract  predispose 
to  constipation. 

Occasonally  it  may  be  relieved  by  the  giving  of  water 
water  between  feedings.  As  one  of  the  functions  of  cream 
fat  in  the  food  is  to  promote  bowel  movements  much 
good  may  result  from  the  administration  of  a  little 
cream,  properly  diluted,  after  nursing,  or  by  the  in- 
crease of  this  element  in  the  baby's  bottle,  if  he  is 
artificially  fed.  For  the  same  purpose  a  few  drops 
of  olive  or  cod  liver  oil,  which  babies  take  readily, 
may  be  given  after  each  meal.  Care  must  be  taken 
not  to  develop  fatty  diarrhea  or  stomach  intolerance 
with  up  spitting  or  vomiting  as  a  result  of  fat  indi- 
gestion. 

For  older  infants  and  children  molasses  taffy  given      Massage 
after  food  has  a  laxative  effect  and  much  benefit  may 
be  derived  from   fresh  fruits  and  fruit  juices  given 
regularly  when  tolerated. 

At  all  ages  daily  gentle  massage  of  the  abdomen 
to  stimulate  the  peristoltic  action  of  the  intestine 
should  never  be  neglected  with  children  having  a  tend- 
ency to  constipaticn.  To  be  most  effective  the  abdo- 
men should  be  stroked  and  kneaded  gently  and  firmly, 
following  the  course  of  the  large  intestine,  namely,  up- 
wards on  the  right  side,  across  above  the  navel  and 
downwards  on  the  left  side  towards  the  groin. 

Where   the   food  is   concentrated   and  quickly   ab-      coarse 
sorbed,  constipation  calls  for  coarser  and  more  bulky 
food  so  that  older  children  should  be  given  coarsely 


130  CARE  OF  CHILDREN 

ground  cereals,  as  cracked  wheat,  corn  bread,  graham 
bread,  also  fruits,  as  grapes  with  the  seeds,  figs  and 
stewed  prunes. 
Drugs         The  frequent  use  of  drugs  for  constipation  should 
be  discouraged  and  should  rarely  be  resorted  to  ex- 


HARD  RUBBER  INFANT  SYRINGE 

cept  by  the  advice  of  the  family  physician.  In  obsti- 
nate cases  the  bowels  may  be  relieved  by  an  occasional 
enema  of  soapy  water  or  sweet  oil. 
Regularity  Regularity  is  most  important.  As  stated  on  page 
40  this  may  be  taught  to  infants  at  an  early  age  with, 
perhaps,  the  assistance  of  a  "suggester"  in  the  form 
of  a  piece  of  soap  whittled  to  a  point.  With  older 
children  a  fixed  time  (preferably  after  the  breakfast) 
for  daily  defecation  should  be  established.  Thus,  and 
by  attention  to  the  diet,  any  tendency  to  constipation 
may  be  overcome  and  many  grave  disorders  of  later 
life  obviated. 

SUMMER  DIARRHEAS 

Summer  diarrheas  are  most  prevalent  and  fatal 
during  the  periods  of  infancy  and  early  childhood, 
the  greatest  susceptibility  to  this  disease  being  found 
between  the  ages  of  six  and  eighteen  months,  which 
time  the  death-rate  is  many  times  that  at  any  other 


DIARRHEAS 


I3i 


age,  hence  mother's  well-known  dread  of  the  baby's 
second  summer. 

In  children  of  all  ages  a  transient  form  may  occur 
at  any  season,  with  decided  predilection,  however,,  for 
the  heated  term.  In  midwinter  occasional  attacks  of 
severe,  although  usually  transcient,  diarrhea  without 
fatal  tendency  are  seen,  but  it  is  in  the  summer  months 
that  intestinal  disorders,  with  diarrhea  as  a  common 
symptom,  are  most  fatal.  The  high  rate  of  mortality 
among  infants  and  children  during  the  summer  months, 
resulting  from  disorders  of  which  diarrhea  is  an  ac- 
companiment, exceeds  that  of  all  other  diseases  dur- 


Mortality 


BULB  INFANT  SYRINGE 


ing  the  same  period.  Nearly  90  per  cent  of  the  deaths 
from  this  cause  are  among  artificially  fed  babies. 

The  immediate  cause  of  summer  diarrhea  is  thought 
to  be  the  presence  of  great  numbers  of  certain  bacte- 
ria found  in  unclean  and  improperly  cared  for  milk. 

The  onset  is  sometimes  sudden,  being  ushered  in  by 
a  convulsion,  vomiting  and  diarrhea.  There  is  usually 
high  temperature,  thirst  and  nausea  which  makes  the 
infant  snatch  at  food  but  push  it  quickly  aside  as  soon 
as  a  few  mouthfuls  have  been  swallowed.    Restlessness 


Onset  of 
Diarrhea 


132 


CARE  OF  CHILDREN 


Vomiting 


Brain  of 
Fluids 


is  nearly  always  present.  The  stools  may  change  sud- 
denly or  may  be  two  or  three  days  in  changing  from 
the  normal  in  frequency  and  character.  There  may  be 
a  great  deal  of  colicky  pain. 

The  infant  while  apparently  in  perfect  health  may 
develop  vomiting,  the  matter  ejected  being  at  first  the 
contents  of  the  stomach  but  little  changed — highly  acid 
or  in  dense  curds ;  this  is  soon  followed,  however,  by 
a  watery,  slimy  and  rarely  by  a  biled-stained  fluid,  less 
acid  or  even  alkaline  in  reaction.  Diarrhea  frequently 
accompanies  and  invariably  follows  the  onset  of  the 
disturbance.  The  first  stools  may  be  nearly  normal 
but  they  quickly  change,  showing  evidence  of  fermen- 
tation and  later  on  putrefaction.  Finally  they  become 
watery  and  may  be  of  a  brownish  or  greenish  color. 
The  odor  of  the  stool  varies  from  the  normal  sour 
to  intensely  putrid  and  later  to  a  sickening  musty 
smell. 

The  infant,  apparently  well  nourished  and  playful, 
quickly  shows  signs  of  systemic  disturbance  in  fretful, 
peevish  irritability  and  restlessness,  with  head  rocking, 
anxious  facial  expression,  persistent  whining  cry, 
fever,  dry  mouth  and  softened  flabby  tissues.  The 
depressed  fontanel,  sunken,  lusterless  eyes,  sharply  de- 
fined temples,  drawn  features  with  the  intense  thirst 
all  give  evidence  of  the  great  drain  of  fluids.  The 
abdomen,  at  first  distended  with  gas,  may  soon  be- 
come flabby  and  depressed  and  the  extremities  cold, 
although  the  rectal  temperature  may  be  from  103  °  to 


DIARRHEAS 


133 


1060  F.  Convulsions  may  usher  in  the  attack,  follow 
the  initial  vomiting  by  a  few  hours,  appear  only  at  the 
final  stage  or  occasionally  they  may  not  develop. 
Within  twenty-four  hours  from  the  onset,  and  fre- 
quently earlier,  the  stage  of  collapse  is  reached,  with 
pallor  and  coldness  of  the  surface,  though  the  internal 
temperature  may  be  high.  The  restlessness  soon  sub- 
sides into  stupor  with  shallow  breathing,  collapsed 
veins,  failure  of  pulse,  half  closed  filmy  eyes  and  death 
occurs  in  convulsions  or  from  exhaustion. 

This  picture  presents  symptoms  of  acute  poisoning 
from  the  stomach  or  intestinal  tract  occurring  in  a 
state  of  apparent  health  and  terminating  fatally  in  from 
twenty- four  to  forty-eight  hours. 

Though  the  well-nourished  infant  is  not  exempt 
from  this  form  of  acute  poisoning  it  occurs  with  much 
greater  frequency  among  those  who  show  evidence  of 
malnutrition. 

Acute  summer  diarrhea  is  frequently  but  improperly 
called  cholera  infantum.  Fortunately  the  true  cholera 
infantum  (caused  by  a  specific  germ)  with  its  almost 
invariably  fatal  termination  is  by  no  means  common. 

The  commonest  form  of  summer  diarrhea  is  the  re- 
sult of  acute  indigestion  usually  caused  by  improper 
or  impure  food  or  overfeeding.  Not  infrequently 
these  attacks  of  vomiting  and  diarrhea  are  relieved  by 
the  giving  of  one  or  more  doses  of  castor  oil  and  the 
withdrawal  of  food  for  twenty-four  hours.  In  such 
cases  the  diet  should  be  resumed  very  gradually,  be- 


Acute 
Poisoning 


Cholera 
Infantum 


Mild 
Cases 


Effects 


134  CARE  OF  CHILDREN 

ginning  with  small  quantities  of  white  of  egg  water, 
barley  water,  strained  broth  or  weak  malted  milk. 
After  A  prolonged  attack  of  summer  complaint  rarely 
leaves  the  child  free  from  evidence  of  retarded  devel- 
opment, which  in  many  instances  is  never  fully  com- 
pensated. Perhaps  the  most  important  effect  of  severe 
summer  complaint  upon  the  survivors  is  the  feeble 
resistance  to  infection  from  lowered  vitality,  so  that 
the  danger  from  contagious  diseases  is  greatly  in- 
creased. 

It  is  needless  to  say  that  the  mother's  immediate 
duty  is  to  summon  her  physician  upon  the  appearance 
of  the  first  symptom  of  summer  diarrheas. 

ABNORMAL  PASSAGES 

The  normal  passages  of  the  infant  have  been  de- 
scribed on  page  JJ,  and  various  abnormal  stools  have 
been  mentioned  in  connection  with  other  disorders, 
but  it  may  be  well  to  summarize  here.  Like  vomiting, 
any  divergence  from  the  normal  in  the  appearance  of 
the  stool  is  a  sign  of  warning.  They  should  be  kept 
for  the  inspection  of  the  physician. 

Stools  may  be  abnormal  in  frequency,  consistency, 
color  and  odor.  During  the  suckling  period  the  baby's 
stools  may  vary  in  frequency  from  one  to  six  daily 
without  apparent  departure  from  health,  the  average 
probably  being  three  movements  in  the  twenty-four 
hours. 

Variations  in  the  quantity  and  quality  of  food  in- 


ABNORMAL  PASSAGES  135 

gested  may  cause  variations  in  the  quantity  and  fre- 
quency of  the  discharges  which,  if  normal  in  color  and 
consistency,  need  occasion  no  anxiety. 

Breast  or  exclusive  milk  feeding  gives  a  light  color      color 
to  the  evacuations,  varying  from  a  canary  to  a  cream. 
As  before  stated,  the  normal  consistency  of  the  suck- 


JOINTLESS  BULB  SYRINGE. 

ling's  stool  is  about  that  of  thin  batter  and  is  smooth 
and  homogeneous  throughout.  But  little  gas  is  pres- 
ent and  the  normal  odor  when  freshly  voided  is 
slightly  sour  and  not  especially  offensive. 

If  cereals,  starch,  sugar  or  proprietary  foods  enter 
largely  into  the  dietary  the  stools  will  be  darker,  rang- 
ing from  orange  to  brown  with  a  greater  tendency  to 
gas  formation  and  a  disagreeable  odor. 

Stools  are  abnormal  when  they  have  a  putrid  odor      Odor 
suggestive   of  decomposition ;  when  they  are  bubbly 
or  yeasty,  suggestive  of  fermentation;  when  they  are 
watery  or  contain  blood  or  mucus ;  when  they   are 


136  CARE  OF  CHILDREN 

heterogeneous  in  character;  when  they  are  acrid  and 
irritate  the  anus  and  skin  of  the  buttocks;  when  they 
are  green  or  variegated  in  color  or  gray  and  tough  or 
putty  like;  when  they  are  hard  and  lumpy  like  mar- 
bles coated  with  slime  or  when  they  are  dry  and 
crumbly,  either  dark  brown,  pale  gray  or  white. 
Mucus  Mucus  is  normally  present  in  the  discharges,  but  it 
is  only  when  irritation  of  some  part  of  the  mucous 
membrane  of  the  digestive  tract  has  caused  an  extra 
abundant  flow  that  it  becomes  visible.  Curds  in  the 
passages  indicate  incomplete  digestion,  the  causes  of 
which  are  many  and  sometimes  hard  to  determine. 
The  quantity  of  food  may  be  too  great,  or  it  may  be 
too  strong,  it  may  be  taken  too  rapidly,  too  often,  too 
cold,  there  may  have  been  chilling  of  the  baby  or  too 
much  excitement,  and  so  on. 

Although  some  of  these  conditions  may  be  remedied 
by  the  judicious  use  of  castor  oil  and  slight  changes  in 
diet,  or  manner  of  feeding,  they  all  suggest  the  advice 
of  the  physician,  before  the  underlying  causes  lead  to 
disorders  which  may  become  obstinate. 

RICKETS   MALNUTRITION  AND  SCTTRVY 

Rickets  (rachitis),  Malnutrition  (marasmus)  and 
Scurvy  (scorbutus)  are  essentially  nutritional  disor- 
ders, and  as  such  depend  both  for  their  treatment  and 
cure  largely  upon  proper  feeding. 

The  rickety  child  shows  a  constitutional  perversion 
of  development  which,  if  not  arrested,  may  lead  to  ac- 


RICKETS 


137 


tual  deformities.  There  is  lessened  resistance  to  dis- 
orders of  an  infectious  nature,  hence  a  marked  tend- 
ency to  catarrhal  conditions  of  all  the  mucous  tracts. 
Early  deaths  from  acute  diseases  are  frequently  due 
to  the  feeble  resistance  of  the  rickety  constitution. 
Rickets  is  oftenest  seen  in  children  between  the  ages 
of  six  months  and  four  years,  though  some  of  its 
effects  are  visible  throughout  life. 

Three  groups  of  symptoms  and  signs  stand  out  pre- 
eminently as  rachitic. 

First.  The  nervous  system  shows  instability ;  there 
is  fretfulness,  irritability  and  intellectual  precocity. 
Tendency  to  spasmodic  seizures  is  sometimes  marked. 
A  form  of  general  spasm,  known  as  "tetany"  being 
peculiar  to  the  rachitic  infant.  So,  also,  the  crowing 
spasms  so  frequently  mistaken  for  croup  are  essen- 
tially rachitic.  The  bright,  fidgety  child  who  runs  on 
his  toes  and  the  head-sweating,  restless,  cover  kicking, 
sleep  moaning  infant  suggest  the  same  rachitic  disturb- 
ance of  nerve  function. 

Second.  The  muscular  system  shows  tardy  devel- 
opment in  strength  and  remains  flabby,  so  that  the  in- 
fant is  late  in  learning  to  stand  or  walk  and  does  not 
sit  erect.  Curvatures  of  the  spine  frequently  show  the 
inefficiency  of  the  muscles  to  support  the  trunk.  The 
child,  meanwhile,  may  appear  to  the  uninformed  as 
well  nourished ;  in  fact,  may  be  fat  or  overfat  with 
pin-cushiony  pads  on  the  top  of  his  feet  and  the  back 
of  his  hands.  His  inability  to  stand  is  frequently  at- 
tributed to  his  great  weight. 


Nervous 
Symptoms 


Muscular 
Development 


i38  CARE  OF  CHILDREN 

Bony  Third.    This  group  consists  of  signs  induced  by  the 

indications  peculiar  retardation  of  bone  growth,  such  as  late  clos- 
ure of  the  fontanel,  square  shaped  skull,  with  lateral 
ridges  and  bulging  forehead,  very  late  and  irregular 
dentition,  enlargements  at  the  ends  of  the  long  bones 
showing  prominently  above  the  wrist  joint  and  at  the 
ends  of  the  ribs  where  they  join  the  cartileges  of  the 
breast  bone.  These  nodules  extend  from  the  upper 
part  of  the  chest  in  two  receding  lines  downward  and 
outward  like  an  inverted  V  and  from  their  resemblance 
to  beads  are  known  as  the  rachitic  rosary.  The  bones 
of  the  rachitic  are  slow  in  hardening,  hence  their 
ready  bending  under  weight,  or  pressure  resulting  in 
bow  legs  or  knock  knees.  The  chest,  too,  in  later  life 
shows  permanent  deformities  and  the  "pigeon  breast" 
is  a  lasting  witness  to  a  rachitic  infancy.  Babies  fed 
on  good  breast  milk  very  rarely  show  rickets. 

Successful  treatment  depends  upon  the  recognition 
of  the  earliest  rachitic  symptoms  in  their  incipiency, 
namely,  those  of  the  first  group.  The  physician  should 
be  consulted  early,  as  too  often  this  condition  is  neg- 
lected until  the  third  group  or  bony  changes  are  well 
under  way. 

Rachitic  infants  often  show  large  abdomen  with 
narrow  chest  and  a  marked  flaring  of  the  lower  border 
of  the  ribs.  They  are  especially  prone  to  digestive 
and  respiratory  disorders  and  frequently  show  signs 
of  tenderness  about  the  chest  and  trunk  when  lifted. 


MALNUTRITION 


139 


Since  a  paucity  of  fat  in  the  food  is  largely  responsi- 
ble for  this  disorder  that  constituent  should  be  freely, 
though  judiciously,  supplied,  while  the  inert  starchy 
constituents  and  the  excessive  fattening  and  gas  form- 
ing sugars  should  be  reduced.  Meanwhile  the  physi- 
cian may  endeavor  to  secure  a  better  supply  of  earthy 
salts  for  the  deficient  bone  forming  constituents. 

Marasmus  is  a  special  term  applied  to  that  general 
form  of  malnutrition  which  seems  to  be  seated  upon 
an  inherited  or  inherent  vice  of  nutrition.  It  goes 
without  saying  that  if  the  feeding  of  a  normal  baby 
requires  judgment  that  of  the  marantic  infant  will  ex- 
ercise the  highest  skill  of  the  ablest  physician.  "Weakly 
from  birth"  is  the  common  expression  applied  to  these 
babies  whose  death  could  be  ascribed  to  no  definite 
disease.  Of  course,  malnutrition  may  result  from  mal- 
hygiene  in  what  would  otherwise  prove  to  be  a  nor- 
mal infant,  and  rachitis,  one  of  the  results,  not  only 
of  improper  feeding  but  also  of  bad  environment  as 
to  pure  air,  sunlight  and  warmth,  plays  no  small  part 
in  the  production  of  marasmus. 

No  one  may  prescribe  the  exact  line  of  feeding  or 
treatment  for  an  unseen  case  of  malnutrition.  Since 
no  two  marantic  children  present  the  same  specific 
disturbances.  There  is  usually  the  extreme  emacia- 
tion which  gives  the  infant  the  appearance  of  senility. 
The  rheumy  lack  luster  eye,  the  weazened  face,  feeble 
wail  and  voracious  hunger,  presents  a  vivid  picture  of 
starvation,  while  the  large  abdomen  and  frequent  foul 


Malnutrition 


Feeding 


140  CARE  OF  CHILDREN 

smelling  stools  with  or  without  vomiting  emphasizes 
the  need  of  most  careful  feeding.  How  to  do  this  is 
the  special  problem  for  the  doctor  in  each  individual 
case.  That  any  intercurrent  infection  should  speedily 
terminate  the  existence  of  the  marantic  infant  is  not 
surprising, 
scurvy  Scorbutus  is  a  disease  occurring  only  in  infants  fed 
continuously  on  cooked  food  and  is  never  seen  in  the 
baby  fed  exclusively  at  the  breast.  The  modern  tend- 
ency or  fad  for  artificial  baby  foods  and  sterilized  milk 
is  largely  responsible  for  the  increasing  frequency  of 
this  disorder  in  recent  years. 

Scorbutus  is  so  eminently  a  food  disorder  that  no 
treatment  is  necessary  other  than  the  proper  change 
in  diet.  The  earliest  symptom  is  crying  when  the  in- 
fant is  handled  as  in  bathing,  changing,  dressing,  etc., 
and  the  nurse  may  discover  that  it  is  the  legs,  espe- 
cially the  thighs,  that  are  tender  to  the  touch.  Some- 
times a  swelling  is  observed  about  the  inner  or  back 
part  of  the  thigh,  above  the  knee,  with  a  red  or  blue 
discoloration  as  from  a  bruise.  Frequently  the  swell- 
ing is  marked  and  the  limb  so  tender  that  rheumatism 
is  suspected.  Black  and  blue  spots  are  occasionally 
seen  on  different  parts  of  the  body  or  limbs,  the  re- 
sult of  ordinary  handling.  The  absence  of  fever  (the 
temperature  is  usually  subnormal)  excludes  rheuma- 
tism and  ordinary  inflammations.  Later  the  skin  shows 
purple  spots  due  to  "blood  settling,"  and  sometimes 
bright  red  spots,  the  size  of  a  pin  head,  under  the 
skin  as  though  a  little  artery  had  leaked. 


COLDS 


141 


The  baby  takes  nourishment  poorly  and  may  have 
indigestion  with  diarrhea.  The  inside  of  the  mouth 
is  dark  red,  the  swollen,  spongy  gums  bleed  readily 
upon  pressure.  Occasionally  blood  is  vomited  which 
had  previously  been  swallowed  from  the  mouth.  Later 
still,  hemorrhages  may  occur  from  any  mucous  tract 
and  the  stools  show  blood  in  clots  like  liver  or  changed 
to  the  appearance  of  coffee  grounds.  Without  relief 
death  soon  follows. 

For  treatment  cooked  food  must  be  replaced  by 
something  raw.  A  teaspoonful  of  orange  juice,  di- 
luted, may  be  given  5  or  6  times  a  day.  Raw  milk 
properly  modified,  raw  beef  juice ;  the  white  of  egg 
will,  if  not  too  late  in  its  administration,  bring  about 
a  remarkable  change. 


Treatment 


COLDS 

Ordinary  colds  are  the  infections  from  the  ever 
present  micro-organisms  which  cause  catarrhal  in- 
flammation of  some  mucous  tract  when  normal  resist- 
ance is  lessened.  Lessened  resistance  may  be  due  to 
lowered  temperature  from  exposure,  from  over  fa- 
tigue, excitement,  loss  of  sleep,  mal-nutrition  or  indi- 
gestion. Also  from  over-feeding,  occasional  or  ha- 
bitual. Impure  air,  also,  lowers  vitality  and  invites 
infection. 

Acute  catarrh  (acute  cold)  may  affect  the  mucous 
membrane  of  the  nose    (Rhinitis)  ;  mouth    (Stomati- 


No    Germs 
No  Colds 


142 


CARE  OF  CHILDREN 


Common 
Cold 


tis)  ;  the  middle  ear  (Otitis)  ;  the  eyes  (Conjuncti- 
vitis) ;  the  pharynx  (Pharyngitis)  ;  tonsils  (Tonsilli- 
tis) ;  larynx  (Laryngitis)  ;  bronchial  tubes  (Bron- 
chitis) ;  stomach  (Gastritis)  ;  bowels  (Enteritis)  ; 
large  bowel  (Colititis  or  Dysentery)  ;  bladder  (Cys- 
titis) ;  or  the  genitals  (Urethritis,  Vaginitis  or  Vul- 
vitis). 

Catarrh  rarely  is  confined  to  a  single  area  but  shows 
a  tendency  to  extend  along  the  continuous  mucous  lin- 
ing to  adjacent  tracts.  Repeated  acute  attacks  tend 
to  become  chronic  under  neglect  and  low  vitality.  The 
secretions  or  discharges  from  any  catarrhal  tract  will 
positively  infect  another  which  is  susceptible,  hence 
their  prevalence  and  the  term  "common  cold."  No 
cold  is  trivial.  All  colds,  with  discharges,  are  con- 
tagious. 


Frequent 
Symptom 


SORE  THROAT 

Sore  throat  is  always  due  to  infection,  and  though 
it  may  prove  trivial  it  should  never  be  so  regarded, 
as  it  is  frequently  the  forerunner  of  a  most  grave  dis- 
ease. No  physician  ever  fails  to  examine  the  throat 
of  a  sick  child,  and  the  mother  should  always  do  so. 
The  tonsils  are  very  commonly  the  seat  of  disease 
from  which  infection  readily  gains  access  to  the  blood 
and  system.  Recurrent  attacks  of  acute  tonsillitis  re- 
sult in  permanent  enlargement  of  these  structures  with 
increased  tendency  to  acute  attacks,  and  absorption  of 
poison  which  causes  enlargement  of  the  neck  glands. 


SORE  THROAT 


143 


The  throat  may  become  nearly  closed,  breathing  in- 
terfered with,  voice  is  changed  and  relief  is  found  only 
in  removal  of  the  tonsil  by  the  surgeon. 

The  space  above  the  tonsils,  behind  the  soft  palate 
and  at  the  top  of  the  pharynx,  is  most  important.  It 
may  well  be  called  the  anarchist's  den,  for  here  hidden 


DIAGRAM  OP  THE  MOUTH. 
The  "Anarchist's  Den"  is  above  the  "Pharyngeal  Isthmus1 


from  sight  more  dangerous  infections  are  cultivated 
than  in  any  other  part  of  the  body.  It  is  called  the 
"post  nasal  space."  Into  it  open  from  in  front  the 
passages  from  the  nose ;  from  the  sides,  the  tubes  from 


144  CARE  OF  CHILDREN 

the  middle  ears ;  and  from  below,  the  upper  end  of 
the  pharynx.  It  is  warm,  moist,  dark  and  ventilated, 
an  ideal  place  for  the  growth  of  micro-organisms 
which  find  in  the  catarrhal  secretions  of  its  mucous 
lining  their  ideal  food.  All  nasal  catarrhs  extend  to 
this  space,  and  the  hawking  and  spitting  is  due  to  ac- 
cumulations here. 
Adenoids  Repeated  attacks  of  catarrh  (cold  .  in  the  head) 
cause  soft  warty  growths,  called  Adenoids,  or  "the 


AN  OIL  ATOMIZER 

third  tonsil,"  which  sometimes  fill  this  space,  blocking 
the  ear  tubes,  causing  ear  disease  and  deafness,  shut- 
ting off  the  air  and  forcing  the  child  to  breathe 
through  the  mouth  with  snoring  in  sleep.  These 
adenoids  give  to  the  voice  a  nasal  tone,  change  the 
shape  of  the  face,  raise  the  roof  of  the  mouth  which 
gives  the  child  a  stupid  expression  and  ultimately  af- 
fects both  mind  and  body.  The  only  cure  when  well 
advanced  is  in  removal  by  the  surgeon, 
care  of  The  early  habitual  care  of  the  nose,  naso-pharynx 
and  throat  by  sprays  and  washes  will  do  much  to  pre- 


the  Nose 


CROUP 


145 


vent  the  numerous  ills  due  to  the  neglect  of  this  im- 
portant area. 

With  a  child  subject  to  colds,  the  oil  atomizer  should 
be  used  daily,  night  and  morning.  Alboline  with  some 


GIVING  A  NASAL  DOUCH. 


medication  such  as  menthol  will  be  prescribed  by  a 
physician.  The  formula  may  need  to  be  weakened  at 
first  by  adding  plain  alboline  until  the  child  becomes 
accustomed  to  the  treatment 


Oil 
Atomizer 


CBOTTP 


There  are  two  forms  of  croup,  spasmodic  and  diph- 
theritic. The  first  form  occurs  usually  at  night.  The 
child  may  or  may  not  have  shown  signs  of  illness  be- 
fore going  to  sleep.     Frequently  he  has  been  troubled 


Kinds 
of  Croup 


146  CARE  OF  CHILDREN 

with  a  cold  and  some  hoarseness  during  the  day.  Sud- 
denly he  is  awakened  with  a  barking,  metallic  (croupy) 
cough  and  may  sit  up  struggling  for  breath.  He  may 
have  noisy  inspirations  with  all  the  symptoms  of  im- 
pending suffocation.  The  doctor  is  hurriedly  sum- 
moned, but  ere  his  arrival  the  paroxysm  has  passed  and 
the  child  is  sleeping  with  little  evidence  of  disturb- 
ance, or  the  attack  may  recur  three  or  four  times  in 
the  night.  Usually  the  second  night  sees  a  return, 
although  he  has  spent  the  day  comfortably.  A  return 
on  the  third  night  is  not  uncommon  but  with  lessened 
severity.  Children  rarely  die  in  these  attacks,  as  the 
suffocation  relieves  the  spasm  of  the  larynx,  allowing 
the  air  to  enter  freely  again.  Some  children  are 
"croupy"  while  others  are  exempt.  Cold  and  damp- 
.  ness  are  the  usual  exciting  causes.  The  attacks  are 
commonest  from  2  to  3  years  and  are  rarely  seen  after 
the  sixth  year. 
Emetic         For  croupy  children  an  emetic  (see  Medicine  Chest) 

for  Croup 

should  be  kept  in  the  house  and  a  dose  administered 
before  sending  for  the  doctor. 

Diphtheritic  croup  is  laryngeal  diphtheria,  one  of 
the  diseases  most  to  be  dreaded.  It  may  complicate 
a  previously  existing  diphtheria  of  the  throat  or  nose 
or  the  disease  may  make  its  first  appearance  in  the 
larynx.  The  symptoms  are  continuous  and  increasing 
air  hunger  with  great  restlessness  and  weakness.  A 
physician  should  always  have  the  case  in  charge  with 
the  assistance  of  a  trained  and  experienced  nurse. 


TEMPERATURE  147 

TEMPERATURE 

Elevation  of  temperature   in  infants  and   children      cause 
may  be  due  to  slight  causes  but  should  never  be  dis-      slight 
regarded.     Fever  is  an  indication  for  rest  and  careful 
watching,  and  in  an  acute  attack  food  should  be  re- 
duced or  entirely  withheld. 


TAKING  TEMPERATURE  BY  RECTUM. 

Fever  due  to  indigestion  from  over  or  improper 
feeding  is  not  uncommon,  while  on  the  other  hand  in- 
sufficient food  may  cause  elevation  of  temperature 
known  as  "inanition  fever."  When  due  to  indiges- 
tion, fever  may  be  relieved  by  removing  the  offending 
material  by  means  of  a  brisk  cathartic  (castor  oil),  or 
copious  enema,  or  both.  Inanition  fever  calls  for 
nourishment. 

A  daily  rise  in  temperature  of  from  2  to  4  degrees 
long  continued,  especially  in  the  evening,  is  suggestive 
of  tuberculosis. 

A  continued  fever  or  a  daily  rise  in  temperature  de-      sponging 
mands  medical  advice.     Feverish  conditions  may  be 
greatly  allayed  by  tepid  sponging  or  the  cool  bath. 


NERVOUS  DISORDERS 


Exciting 
Causes 


Symptoms  of 
Nervousness 


An  excitable  condition  called  nervousness  is  usually 
due  to  unbalanced  nutrition  or  insufficient  rest.  In- 
heritance may  exert  an  influence  as  a  remote  or  pre- 
disposing cause  and  the  "nervous  temperament"  has 
long  been  recognized. 

Among  the  exciting  causes  may  be  mentioned  fa- 
tigue, indigestion,  foreign  bodies  in  the  digestive  tract, 
as  worms ;  local  irritations  which  by  reflex  action  dis- 
turb nerve  equilibrium,  as  disorders  of  the  genitals, 
irritable  bladder,  constipation,  seat  worms ;  inflamma- 
tion of  the  middle  ear ;  growths  in  the  naso-pharynx ; 
eye  strain;  skin  eruption  as  eczema,  etc.  Also  im- 
proper clothing  which  occasions  unequal  temperature 
or  discomfort. 

Some  of  the  manifestations  are  seen  in  disturbed 
sleep,  grinding  of  teeth,  bad  dreams,  night  terrors, 
muscular  twitchings,  chorea  (Saint  Vitus's  dance), 
convulsions  or  epilepsy. 

Some  of  the  minor  symptoms  appear  as  fidgeting, 
squirming,  grimacing,  blinking,  chewing,  nail  biting, 
head  scratching,  picking  at  the  nose,  bed  wetting  and 
ready  crying,  which  to  the  experienced  eye  proclaim 
some  nerve  irritation. 

Children  should  rarely  be  punished  but  rather  fed 
for  the  correction  of  these  involuntary  manifestations 
of  nervousness.  The  wise  parent  will  always  consult 
the  physician  in  these  cases. 

148 


Convulsions 


NERVOUS  DISORDERS  149 

CONVULSIONS,  SPASMS,  FITS,  CRAMPS 

In  the  category  of  infantile  disorders  nothing  is 
more  dreaded  and  no  childhood  ailment  demands  great- 
er presence  of  mind  on  the  part  of  the  mother.  It  has 
frequently  been  stated  that  children  rarely  die  of 
spasms,  that  is,  the  convulsion  of  itself  rarely  kills. 
Spasms  do  not  constitute  the  disease,  but  are  only 
symptoms  of  some  disorder  which  disturbs  the 
equilibrium  of  the  nervous  system. 

We  have  seen  that  reflex  action  was  highly  devel-  cause  of 
oped  at  birth  and  that  inhibition  (control)  was  a  func- 
tion of  later  development.  The  younger  the  infant 
the  greater  the  likelihood  of  muscular  contractions 
being  excited  beyond  control  of  the  feeble  inhibition. 
Therefore  anything  which  powerfully  excites  mus- 
cular contraction  may  induce  convulsions  in  infants 
and  young  children. 

Hyper-excitability  and  feeble  inhibition  are  also  to 
a  certain  extent  hereditary.  The  so-called  nervous 
constitution  finds  its  best  expression  in  this  want  of 
balance  between  excitability  and  inhibition.  Nutri- 
tion also  plays  an  important  part  in  determining  the 
balance  between  these  two  functions  of  the  nervous 
system  (see  Rickets).  What  might  be  a  very  trifling 
disturbance  in  the  adult  may  induce  convulsions  in 
the  infant  Again  spasms  may  be  one  of  the  symp- 
toms of  a  very  grave  disease.  It  is  the  cause  of  the 
fits,  then,  that  is  of  paramount  importance. 


ISO  CARE  OF  CHILDREN 

From  the  above  may  be  seen  some  of  the  reasons 
why  spasms  are  frequently  among  the  terminal  symp- 
toms of  a  fatal  disease,  so  that  death,  not  of  but  in 
convulsions,  is  not  infrequent  in  young  infants. 

Among  the  various  causes  are  the  onset  of  some 
severe  illness  as  scarlet  fever,  pneumonia,  brain  dis- 
ease, etc.,  or  convulsions  may  be  induced  by  indiges- 
tion, constipation,  intestinal  worms,  high  fever,  very 
hot  weather,  severe  pain  or  fright.  The  ordinary  chill 
in  the  adult  may  be  expressed  by  a  spasm  in  the  infant. 
Symptoms  The  symptoms  of  a  spasm  may  be  so  slight  as  almost 
to  escape  notice,  such  as  transient  eye  squint,  turning 
in  of  the  thumbs  or  great  toe,  slight  muscular  twitch- 
ings  of  the  face  or  jerking  of  the  trunk  muscles. 
These  evidences  of  so-called  "internal  spasms"  may 
pass  away  or  may  prove  the  beginning  of  violent  con- 
vulsions, hence  should  not  be  disregarded. 

General  convulsions  involve  nearly  all  the  muscles 
of  the  head,  trunk  and  limbs.  Usually  there  is  a  pe- 
culiar choking  sound  in  the  throat;  the  twitching  fea- 
tures become  set ;  the  eyes  fixed  and  staring,  crossed  or 
rolled  upwards,  showing  only  the  whites,  the  body  be- 
comes rigid  with  the  back  arched,  the  hands  clenched 
and  arms  flexed,  the  jaws  firmly  closed  and  if  teeth 
be  present  the  tongue  is  usually  bitten.  The  face  be- 
comes blue  from  suspended  respiration. 

This  rigidity  usually  lasts  but  a  few  seconds  and  the 
child  begins  to  jerk  violently  with  rhythmic  motions 
in  arms,  legs  and  trunk.     An  unnatural  audible  sound 


CONVULSIONS  151 

sometimes  occurs  with  the  breathing  and  the  free  flow 
of  saliva  may  be  churned  into  a  froth  which  clings  to 
the  lip.  The  jerking  then  becomes  less  marked  and 
finally  ceases  and  the  child  soon  recovers  consciousness 
and  cries  or  falls  asleep  from  exhaustion.  This  cycle 
is  usually  completed  in  from  one  to  three  minutes, 
though  to  the  watching  parents  it  may  seem  many 
times  that. 

The  attacks  may  recur  at  intervals  for  many  hours 
if  the  cause  is  not  removed  and  death  has  been  known 
to  occur  apparently  from  exhaustion. 

Since  in  infancy  one  of  the  commonest  causes  of  Treatment 
convulsions  is  indigestion  or  the  presence  of  some  irri- 
tant in  the  digestive  tract  the  first  thing  to  be  done  is 
to  clean  out  the  stomach  and  bowels.  A  prompt 
emetic  should  be  given  at  once,  followed  by  a  dose  of 
castor  oil.  A  copious  enema  of  warm  salt  solution 
(teaspoonful  of  salt  to  a  pint  of  warm  water)  should 
also  be  given. 

For  the  relief  of  the  immediate  spasm  the  child 
should  be  quickly  immersed  in  a  hot  bath  (temperature 
no°  F.  or  test  with  the  whole  arm)  containing  a  tea- 
spoonful  of  strong  mustard  to  the  gallon,  with  ice  cold 
cloths  to  the  head.  A  simpler  method  of  applying 
moist  heat  is  to  wrap  the  baby  in  a  small  blanket  or 
turkish  towel  wrung  out  of  hot  water. 

A  physician  should  be  at  once  summoned,  but  if  he 
is  not  in  reach  and  the  convulsions  recur  an  enema  of 
five  grain  tablet  of  sodium  bromide  dissolved  in  an 


152  CARE  OF  CHILDREN 

ounce  of  tepid  water  may  be  administered  and  retained 
by  pressure  upon  the  anus,  or  half  this  dose  may  be 
given  by  mouth  to  a  child  of  18  months,  every  two 
hours  if  necessary. 


A  NIGHT  LIGHT. 

Effects  Although  as  stated,  death  is  rarely  due  to  a  convul- 
sive seizure,  it  is  none  the  less  to  be  dreaded,  and  all 
means  should  be  employed  to  ward  off  its  recurrence, 
for  the  reason  that  severe  spasms,  from  whatever 
cause,  may  result  in  permanent  injury  to  the  delicate 
tissues  of  the  brain,  among  the  results  of  which  may 
be  paralysis,  with  mental  impairment. 


CONTAGIOUS  DISEASES 

Contagious  diseases  are  those  due  to  germs  carried  f°j£°tel0°n 
to  the  individual  from  some  other  person  suffering 
from  that  disease.  These  germs  may  come  through 
direct  contact  or  may  be  brought  by  air,  water,  food, 
clothing,  books,  papers,  letters,  etc.,  so  that  the  source 
from  which  the  child  is  exposed  is  often  difficult  to 
trace. 

Of  the  contagious  diseases  we  will  consider  only 
those  most  commonly  found  in  infancy  and  childhood, 
viz.,  measles,  scarlet  fever,  chicken-pox,  diphtheria 
and  whooping  cough.  They  have  a  common  resem- 
blance in  that  they  have  a  stage  of  incubation  (the 
interval  from  exposure  to  the  first  symptoms),  all  are 
self  limiting  diseases  (run  out  their  course),  all  are 
accompanied  by  more  or  less  fever,  one  attack  usually 
immunes  from  a  second  (except  in  diphtheria),  each 
has  the  characteristic  skin  eruptions  (except  diph- 
theria and  whooping  cough),  and  each  has  its  stage  of 
invasion  (the  interval  between  the  first  symptoms  and 
the  appearance  of  the  characteristic  symptom). 

MEASLES 

Measles,  German  measles,  scarlet  fever  and  chicken-      Eruptive 
pox  are  called  the  "eruptive  fevers." 

Measles  is  the  most  frequent  and  most  contagious, 
attacking  all  ages  and  is  most  prevalent  in  the  winter 
season.  It  is  contagious  during  stages  of  incubation, 
probably  from  the  breath  of  the  patient,  and  is  rarely 
carried  by  a  third  person.     Though  lightly  regarded 

153 


Fevers 


154  CARE  OF  CHILDREN 

by  most  people,  measles  is  a  very  serious  disease,  espe- 
cially in  delicate  children,  where  it  may  prove  fatal 
from   the   broncho-pneumonia   or   tuberculosis    which 
frequently  follows  it. 
Symptoms         The  attack  begins  with  the  symptoms  of  a  bad  cold ; 

of  Measles  J       r  . 

eyes  red,  nose  wet,  fever,  hoarseness,  sneezing  and 
cough,  with  slight  sore  throat,  coated  tongue  and  fe- 
verish breath.  About  the  fourth  day  the  rash  appears, 
first  on  the  face,  gradually  spreading  downward  over 
the  trunk  and  limbs,  which  it  usually  covers  in  twenty- 
four  hours.  This  consists  of  dusky  red,  slightly  ele- 
vated, flattened  papules,  from  wheat  grain  to  split  pea 
in  size.  On  the  face  and  trunk,  especially,  they  run 
together,  giving  a  blotchy  look  to  the  dark  red  with 
little  spaces  of  normal  skin  between.  The  rash  period 
is  less  than  a  week  and  fades  away  gradually. 

The  eyes  may  be  very  troublesome  and  permanent  im- 
pairment often  follows.  The  cough  may  increase  with 
symptoms  of  pneumonia.  The  fever,  in  uncompli- 
cated cases,  subsides  with  the  rash,  which  is  followed 
by  a  falling  off  of  fine  branny  scales  continuing  dur- 
ing the  week  of  convalescence.  Treatment:  Call  a 
doctor,  avoid  bright  light  and  put  child  to  bed  in  a 
warm  room. 

GERMAN  MEASLES    (ROETHELN) 

A  milder  disease  than  measles,  for  which  it  is  fre- 
quently mistaken.  It  generally  comes  in  epidemic 
form  in  the  winter  season.  The  rash  appears  on  the 
second  day,  first  on  the  face  in  pale  rose  spots  slightly 


SCARLET  VEVER  155 

elevated,  size  of  pin  head,  which  usually  rei.iain  sepa- 
rate. When  they  do  run  together  they  do  not  form 
blotches  like  measles  but  rather  a  continuous  redness 
like  scarlet  fever,  for  which  it  is  sometimes  mistaken. 
The  rash  spreads  downward  rapidly  over  the  body, 
at  the  same  time  beginning  to  fade  from  the  face  so 
that  in  three  days  it  has  disappeared.  The  fever  is 
slight,  with  a  little  sore  throat  and  wet  eyes  and  nose. 
Usually  small  scales  from  the  outer  skin  fall  off  a  few 
days  after  the  rash. 

Treatment:  Protect  from  broncho-pneumonia  by 
keeping  in  bed  on  light  diet. 

SCARLET  FEVEE  (SCAELETINA) 

Scarlet  fever  is  very  common  at  all  ages  above  six 
months.  Occurs  most  frequently  in  Autumn  (after 
schools  open)  and  is  very  contagious.  The  germs 
may  be  carried  in  clothing  and  may  live  for  a  year 
stowed  away  in  clothes  and  bedding. 

The  disease  may  be  so  mild  as  to  be  overlooked  or  viruiem* 
so  severe  as  to  destroy  life  in  24  hours.  The  mildest 
case  may  furnish  germs  for  one  of  the  severest  type, 
hence  the  importance  of  recognizing  and  isolating 
every  case.  It  usually  comes  on  suddenly  with  vomit- 
ing. High  fever  appears  on  the  first  day  and  rash  on 
the  second.  Eruption  first  appears  on  the  neck  and 
spreads  rapidly  over  the  body  and  limbs  but  usually 
spares  the  face.  The  color  is  uniformly  scarlet  in  typ- 
ical cases  with  pin  points  of  intense  red  showing 
through.     The  throat  is  red  and  sore  from  the  begin- 


156  CARE  OF  CHILDREN 

ning  of  invasion  and  may  develop  a  whitish  membrane 
like  diphtheria.  The  tongue,  at  first  white  coated 
with  red  points  showing  through,  cleans  off  so  that  by 
the  third  or  fourth  day  it  has  the  glistening  red  rasp- 
berry appearance,  called  "strawberry  tongue.'' 
Duration  The  fever  lasts  a  week  or  ten  days,  the  rash  from 
five  to  eight  days.  A  mild  attack  may  suddenly  de- 
velop alarming  symptoms  and  may  be  followed  by 
ear  disease,  enlarged  glands  of  the  neck,  rheumatism, 
heart  disease  or  Bright's  disease.  The  latter  after  2 
or  3  weeks.  Treatment :  Isolate  the  child  and  send 
for  the  doctor. 

CHICKEN  POX  (VARICELLA) 

Chicken  pox  is  very  common.  Limited  to  no  age, 
and  may  be  carried  by  a  third  person.  Onset  mild. 
F/equently  the  first  symptom  is  the  eruption  of  small 
rose  colored  spots  on  neck  and  trunk,  which  change  in 
a  few  hours  to  little  blisters  about  the  size  of  a  split 
pea  or  larger,  filled  with  water.  These  stand  out 
prominently,  having  a  narrow  red  ring  around  their 
base.  There  may  be  a  thousand  or  only  ten  at  one 
time  on  the  entire  body.  The  blisters  dry  down  and 
scab,  and  another  crop  appears  so  that  spots,  blisters 
and  scabs  may  all  be  present  at  once. 

About  a  week  terminates  the  eruption  and  the  child 
gets  well.  Scabs  should  not  be  picked  off,  as  pock 
marks  will  result.  Large  blisters  on  the  face  should 
be  pricked  and  treated  by  the  physician  to  prevent 
pitting. 


DIPHTHERIA  157 

DIPHTHERIA 

Before  the  use  of  antitoxin  this  was  an  extremely 
fatal  and  is  even  now  a  dread  disease.  No  age  is  ex- 
empt, though  it  is  rarely  seen  in  very  young  infants. 
It  is  most  prevalent  in  damp  weather  when  sore 
throats  are  common  and  may  develop  in  any  sore 
throat  or  catarrhal  nose  or  larynx.  In  the  latter  sit- 
uation it  is  known  as  "diphtheritic  croup,"  a  most  dan- 
gerous form,  for,  added  to  the  blood  infection  we  have 
the  danger  of  suffocation  from  laryngeal  obstruction. 
In  this  complication  it  is  often  necessary  to  introduce 
a  tube  that  the  child  may  get  air. 

The  germs  of  diphtheria  may  be  carried  long  dis- 
tances and  maintain  their  infective  properties  for 
months.  Hence  the  utmost  care  must  be  observed  to 
isolate  the  child  and  destroy  all  secretions  from  throat 
and  nose.  One  attack  does  not  prevent,  but  rather 
favors,  subsequent  infection. 

The  stage  of  invasion  is  marked  by  feverishness,  loss  symptoms 
of  appetite,  debility  and  sore  throat.  The  reddened 
throat  may  show  one  or  more  whitish  patches  on  one 
or  both  tonsils.  Next  day  both  tonsils  and  soft  palate 
may  be  covered  with  a  thick,  greyish  white  membrane 
which  may  invade  the  naso-pharynx  and  cause  dis- 
charge from  the  nose.  The  breath  is  fetid  and  the 
glands  under  the  angle  of  the  jaws  may  swell  enor- 
mously. No  disease  of  brief  duration  causes  such 
muscular  weakness  as  diphtheria,  and  some  cases  of 
death  from  heart  failure  occur  after  the  child  is  over 
the  disease  itself. 


158 


CARE  OF  CHILDREN 


Treatment:  Prompt  and  strict  isolation  and  most 
rigid  observance  of  the  physician's  orders.  The  acute 
stage  of  this  disease  rarely  lasts  more  than  a  week. 

"WHOOPING    COUGH 

Most  commonly  seen  in  young  children  and  infants. 
It  is  highly  contagious  and  is  seen  at  all  seasons  of  the 
year.  It  usually  comes  through  direct  exposure.  The 
mistaken  idea  that  whooping  cough  is  not  a  dangerous 
disease  has  cost  many  lives. 
Onut  The  onset  is  gradual,  the  stage  of  invasion  lasting 
from  one  to  three  weeks  as  a  mild  bronchitis  before 
the  characteristic  whoop  is  heard.  Some  children  do 
not  whoop,  which  is  merely  the  effect  of  forcible  in- 
spiration after  a  prolonged  paroxysm  of  coughing. 
In  that  case  the  nature  of  the  affection  must  be  deter- 
mined by  the  paroxysmal  character  of  the  cough, 
which  recurs  after  intervals  of  one  to  three  hours,  and 
usually  ends  in  gagging  and  spitting  up  sticky  phlegm 
from  the  throat,  or  vomiting  the  contents  of  the  stom- 
ach without  nausea. 

Between  paroxysms  the  child  may  appear  in  usual 
health  and  spirits.  The  cough  is  worse  at  night. 
Much  food  is  lost  in  vomiting  and  nutrition  suffers. 
The  younger  the  child  the  more  dangerous  the  disease. 
Duration  Whooping  cough  covers  about  two  months.  A 
longer  continuance  is  usually  due  to  the  bronchitis 
which  complicates  it.  The  complication  may  be  se- 
vere and  sometimes  fatal  in  infants.  Lowered  nutri- 
tion is  quite  serious,  and  feeding  should  follow  rather 


FOREIGN  BODIES  159 

than  precede  the  paroxysm  to  secure  retention  of  the 
food  which  must  be  liquid  for  prompt  absorption. 

Treatment:  Bronchopneumonia  and  tuberculosis 
are  important  sequelae.  The  best  of  medical  super- 
vision is  due  in  each  case  but  probably  nothing  is  more 
important  than  abundance  of  fresh  air. 

FOREIGN  BODIES 

The  swallowing  of  foreign  bodies  that  are  not  poi-  Bulky 
sonous  need  cause  no  alarm  or  special  anxiety,  as  the 
bowel  will  usually  discharge  the  body  in  a  few  days. 
Its  passage  may  be  facilitated  and  the  stomach  and 
bowels  protected  from  injury  by  copious  feeding  with 
mush  and  milk  or  bread  stuffs.  As  sometimes  the  ob- 
ject lodges  in  the  narrowing  portion  of  the  oesophagus 
near  its  upper  end,  from  which  it  may  be  recovered  by 
means  of  curved  forceps,  the  physician  should  be  con- 
sulted, or  an  X  ray  examination  had  to  determine  its 
location.  If  the  child  be  choked  by  a  foreign  body  in 
the  throat,  suspension  head  downward  with  slapping 
on  the  back  may  cause  its  ejection. 

In  the  Ear.    A  foreign  body  in  the  ear  which  can      us«  of 
not  be  dislodged  by  syringing  the  ear  with  warm  water      syrln»e 
should  be  sent  to  the  physician.    The  body  itself  is 
harmless  if  no  clumsy  attempts  at  extraction  be  made. 

An  insect  in  the  ear  should  be  drowned  in  sweet  oil 
and  later  washed  out  with  a  syringe. 

In  the  Nose.  A  body  in  the  nose  that  can  not  be 
dislodged  by  blowing  the  nose  or  by  sneezing  should 
be  sent  at  once  to  the  specialist,  as  unskilled  attempts 
at  removal  are  usually  mischievous. 


160  CARE  OF  CHILDREN 

EARACHE 

Earache  may  be  the  first  intimation  of  an  inflamma- 
tion of  the  middle  ear.  The  screaming  infant  may 
sometimes  pull  his  hair  or  put  his  hand  to  the  affected 
side  of  the  head.  Gentle  pressure  with  the  thumb  in 
front  of  or  behind  the  ear  may  cause  flinching  from 
tenderness.  After  pus  has  formed  its  pressure  will 
usually  rupture  the  drum  membrane  and  allow  a  dis- 
charge through  the  external  passage.  Inflammation  of 
the  middle  ear  is  usually  due  to  infection  from  the 
throat  or  naso-pharynx  through  the  tube  (eustachian) 
which  connects  the  two  cavities.     Acute  congestion  of 


RUBBER  EAR  SYRINGE. 

the  ear  with  intense  pain  is  sometimes  the  result  of  ex- 
posure to  cold  or  drafts  and  may  be  relieved  by  hot 
applications  as  salt  or  water  bag.  The  infected  ear 
may  be  gently  filled  with  hot  water  or  warm  sweet 
oil,  care  being  taken  not  to  burn. 
Danger  of  So  great  harm  results  from  neglected  ear  trouble 
Meningitis  t^at  ^e  best  mecijcai  advice  should  be  obtained  upon 
the  appearance  of  the  first  symptoms.  Aside  from 
pain  and  danger  of  impaired  hearing  from  formation 
of  pus  in  the  middle  ear  it  should  be  remembered  that 


EARACHE  161 

this  cavity  is  in  close  relation  to  that  containing  the 
brain,  and  frequent  death  in  infants  and  children  from 
brain  fever  (meningitis)  is  the  direct  result  of  infec- 
tion by  this  route. 

The  relation  of  meningitis  in  children  to  the  neglect- 
ed nose,  throat  and  ear,  is  a  very  intimate  one. 

The  following  table  shows  briefly  a  few  of  the  typical  Table  of 
points  of  resemblance  and  difference  between  these 
six  most  common  contagious  diseases.  It  frequently 
occurs  that  the  disease  so  differs  from  the  accepted 
type,  that  its  recognition  is  extremely  difficult,  requir- 
ing a  careful  consideration  of  symptoms  and  condi- 
tions, the  enumeration  of  which  is  impracticable.  In 
all  cases  the  early  summoning  of  the  family  physician 
is  urged. 


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THE  MEDICINE  CHEST  163 

THE  MEDICINE   CHEST 

A  little  learning  is  a  dangerous  thing,  so  too  is  a      Hygiene 
razor  in  the  hands  of  a  child.     Much  more  harm  may      Medicine 
follow  the  unskilled  use  of  drugs  than  from  their  neg- 
lect.    Pernicious  as  is  constant  "doping"  for  the  adult, 
it  is  much  more  so  for  the  child.     A  complicated  medi- 
cine chest  may  become  a  source  of  endless  mischief  in 
the  household.     "If  it  does  no  good  it  can  not  do  any 
harm"  may  be  said  of  nothing  possessed  of  any  po- 
tency for  either  good  or  evil.     The  following  is  a  brief 
list  of  remedial  agents  for  the  nursery : 
Alcohol. 

Alboline   (or  Lavoline)    for  daily  use  in  the  atomization  of 
nose  and  throat.     In  nasal   catarrh   a  physician  will 
give  a  prescription  for  a  medicated  aboline. 
Boric  Acid.    A  solution  of  a  tablespoonful  to  a  pint  of  boil- 
ing water,  cooled  and  strained  through  gauze  into  a 
sterilized  bottle,  may  be  used  as  a  gargle  or  wherever 
a  mild  antiseptic  wash  is  needed — cuts,  bruises,  etc. 
Bicarbonate  of  Sodium. 
Brandy. 

Bromide  of  Sodium — In  five  grain  tablets,  for  convulsions. 
Castor  oil — the  most  effective  and  least  harmful  cathartic. 
Usual  dose,  2  to  6  months,  1  teaspoonful  of  castor 
oil  and  sweet  oil  mixed ;  under  2  months,  half  the 
amount  of  the  mixture;  up  to  1  year,  about  1  tea- 
spoonful  of  castor  oil;  1  to  4  years,  V/2  to  2  teaspoon- 
fuls  or  more,  according  to  susceptibility.  To  a  child 
old  enough  to  find  the  taste  objectionable  the  castor 
oil  may  be  given  in  a  little  warm  milk  or  coffee  and 
milk,  followed  by  more  milk,  lemonade  or  peppermint 
candy. 


164  CARE  OF  CHILDREN 

Ipecac,  Syrup  of. — As  an  emetic  give  a  year  old  baby  V2  tea- 
spoonful,  followed  by  drink  of  warm  water.  Repeat 
dose  every  15  minutes  until  vomiting. 

Lime  Water. 

Mustard. 

Peppermint,  Essence  of. 

Sweet  oil. 

Vaseline. 


Absorbent  Cotton,  antiseptic. 

Adhesive  Plaster. 

Alboline  Atomizer  (Constructed  to  spray  oils). 

Ear  and  Nose  Syringe.     (Soft  rubber.) 

Fountain  Springe. 

Flexible  rubber  Catheter,  number  10  (for  rectal  tube). 

Gauze,  antiseptic. 

Hot  water  bottle. 


HYGIENE  OF  THE  CHILD  AND  YOUTH 


Getting  the  baby  out  of  arms  should  not  diminish 
the  mother's  care,  but  the  same  protection  as  given 
in  the  nursery  should  extend  throughout  childhood, 
with  such  modifications  as  the  changing  anatomy  and 
physiology  demand.  In  fact,  the  child  of  two  or  three 
years  should  receive  more  of  her  time  and  thought 
than  the  younger  babe,  for  it  is  now  that  his  training 
in  personal  hygiene  should  begin  and  habits  of  per- 
sonal cleanliness  be  established.  After  infancy,  the 
danger  from  death  may  be  lessened  but  not  of  per- 
verted development. 

The  fact  that  a  child  is  able  to  dress  himself  does 
not  relieve  the  mother  of  the  responsibility  of  seeing 
that  he  is  properly  clothed,  and  even  though  he  is  old 
enough  to  sit  at  the  family  table,  especial  attention 
must  still  be  given  to  his  diet  and  manner  of  eating. 
Thorough  mastication  is  a  most  important  feature  of 
the  child's  early  training  and  he  should  not  be  allowed 
to  "wash  down"  his  food.  He  should  eat  some  foods 
requiring  vigorous  mastication,  such  as  toast  and  hard 
cracker,  to  help  in  developing  strong  teeth. 

Too  frequently  the  temporary  teeth  are  neglected 
both  as  to  personal  and  dental  care  under  the  mistaken 
impression  that  their  early  loss  renders, them  of  little 
importance.  Even  were  this  true  (which  it  is  not) 
the  health  and  comfort  of  the  child  would  suggest 
that  they  be  kept  clean  and  in  perfect  condition  as  long 

166 


More  Care 
Not  Less 


Care  of 
the  Teeth 


i66 


CARE  OF  CHILDREN 


Care  of 
the  Throat 


Deep 
Breathing 


as  they  remain.  To  accomplish  this  end  the  teeth 
should  be  thoroughly  brushed  and  the  mouth  cleansed 
with  a  pleasant  antiseptic,  such  as  dilute  listerine,  boro- 
lyptol  or  glyco-thymoline,  night  and  morning  (especi- 
ally at  night)  and  the  slightest  decay  of  the  teeth 
should  be  referred  to  the  dentist. 

After  a  child  is  taught  to  properly  cleanse  his  mouth 
it  is  but  a  short  step  to  teach  him  to  gargle  and  this 
mastered  a  little  tact  and  patience  on  the  part  of  the 
mother  or  nurse  will  soon  initiate  him  into  the  use  of 
the  atomizer  and  nasal  douche,  accomplishments  which 
may  prove  of  inestimable  value  at  some  critical  time. 

Every  night  and  morning  (oftener  if  necessary)  the 
nasal  passages  should  be  freed  from  excessive  secre- 
tion, not  only  so  that  the  child  can  breathe  through 
his  nose  but  to  get  rid  of  material  which  harbors  in- 
fections. The  child  should  early  be  taught  the  use 
of  the  handkerchief  and  required  to  carry  his  own 
and  impressed  with  the  danger  of  contact  with  those 
soiled  by  others. 

Any  tendency  to  mouth  breathing  should  be  immedi- 
ately corrected  and  if  necessary  the  advice  of  a  physi- 
cian sought. 

Deep  breathing  should  be  early  taught  and  insisted 
upon  until  it  becomes  a  firmly  established  habit.  This 
cannot  be  accomplished  with  unsuitable  clothing  or 
without  correct  postures  in  standing,  sitting  and  walk- 
ing. Frequent  exercise  jn  the  open  air,  such  as  taking 
a  deep  inspiration  while  five,  ten  or  even  fifteen  sec- 


HYGIENE  OF  THE  CHILD  167 

onds  are  being  counted,  may  be  made  a  game  of  com- 
petition. 

The  need  of  plenty  of  sleep  throughout  the  entire      sleep 
developing  period  can  not  be  unduly  emphasized  and 
to  this  end  quiet,  well  ventilated  chambers  and  indi- 
vidual beds  are  necessary. 

Young  children  should  retire  soon  after  the  light 
supper.  Studying,  playing  or  reading  by  artificial 
light  may  interfere  with  the  rest  and  recuperation 
required  after  the  fatigue  of  the  day. 

The  frequency,  duration  and  temperature  of  the  Bathing 
bath  should  depend  upon  the  reactionary  effects  upon 
the  child.  A  cold  tonic  shower  bath  is  best  given  in 
the  morning  and  should  not  last  more  than  half  a 
minute.  The  child  should  stand  in  warm  water  which 
covers  his  feet  and  be  gently  sprayed  with  warm  water 
before  turning  on  the  cold  shower.  If  a  shower  bath 
is  not  available,  a  quick  sponge  with  tepid  to  cold 
water  with  a  brisk  toweling  may  be  given.  The 
advisability  of  the  cold  baths  should  be  decided  by  the 
family  physician,  as  all  children  should  not  take  them. 
The  warm  bath  may  be  given  before  retiring  if  suffi- 
cient time  be  allowed  for  the  digestion  of  the  supper. 
General  bathing  should  never  immediately  follow  a 
meal. 

EDUCATION 

Childhood  is  recognized  as  the  p,aytime  of  life  and 
most  of  the  plays  of  children  are  educational  in  their 
tendency.      That    physical  development  and  training 


i68 


CARE  OF  CHILDREN 


Games 
for  Girls 


Development 
of  the  Brain 


should  take  precedence  of  the  mental  is  self-evident  to 
all  who  witness  the  sad  spectacle  of  an  over-trained 
mind  in  a  feeble  body. 

In  childhood,  at  least,  girls  should  share  the  outdoor 
sports  of  their  brothers.  There  is  no  reason  why  the 
pleasurable  and  useful  exercise  of  running,  jumping, 
swimming,  rowing,  skating,  riding,  cycling  and  most 
games  should  be  confined  to  boys.  The  cry  of  "tom- 
boy" has  deprived  many  a  girl  of  the  physical  founda- 
tion for  the  duties  and  responsibilities  of  mature 
womanhood. 

Rousseau  says,  and  truly,  the  weaker  the  body  is, 
the  more  it  commands;  the  stronger  it  is,  the  more  it 
obeys. 

"A  well-trained  nervous  system  is  the  greatest  friend 
that  the  mind  can  have." — Halle ck. 

The  country  affords  special  advantages  for  the  nor- 
mal development  of  the  child,  for  here  it  is  that  he 
comes  close  to  nature  which  furnishes  innumerable 
object  lessons  and  problems  which  his  inherent  curi- 
osity impels  him  to  solve.  Thus  he  is  led  to  develop 
himself  through  a  symmetrical  training  of  muscles 
and  brain.  For  the  city  child,  these  conditions  should 
be  approximated  as  nearly  as  possible. 

The  brain,  relatively  large,  even  at  birth,  is  suscepti- 
ble of  very  rapid  development.  If,  however,  this  be 
allowed  to  exceed  that  of  the  muscles,  irreparable  dam- 
age may  result  and  mediocrity  take  the  place  of  early 
precocity  through  early  exhaustion  of  the  brain  cells 
from  over  stimulation.     It  must  never  be  forgotten 


HYGIENE  OF  THE  YOUTH 


169 


that  young  nerve  cells  tire  quickly,  not  yet  having  the 
stored  energy  of  maturity. 

The  younger  the  child  the  more  should  the  early 
educational  efforts  be  restricted  to  the  larger  groups 
of  muscles, — leg,  arm  and  body  exercise  rather  than 
those  of  the  fingers  and  smaller  groups  of  muscles 
which  require  concentrated  efforts  at  finer  co-ordina- 
tion. The  use  of  the  needle,  pencil,  brush  and  scissors 
may  well  be  deferred  and  replaced  by  romping  games, 
efforts  at  house  building  with  large  blocks  or  shovel 
and  sand  pile. 

The  proverbial  laziness  of  the  boy  of  eight  years  is 
based  upon  a  physiological  fact  which  is  too  frequently 
overlooked.  His  heart  at  this  time  has  not  kept  up 
with  the  rapid  growth  in  body  length  and  is  barely  able 
to  maintain  the  circulation  of  the  blood  for  ordinary 
mental  and  muscular  exertion.  He  is  least  fitted  at 
this  time  for  the  extra  demands  made  upon  him  for 
running  errands  and  doing  all  sorts  of  chores  which 
he  usually  does  clumsily  and  tardily  because  of  ex- 
cessive fatigue.  Many  boys  and  girls  are  stunted  for 
life  or  succumb  to  infectious  disease  from  excessive 
burdens  imposed  during  this  period  of  weak  heart, 
namely,  from  the  eighth  to  the  twelfth  year. 

It  has  been  shown  often  that  the  purpose  of  our  so- 
called  educational  systems  has  been  defeated  by  ig- 
norance of  the  child's  capacity  for  concentrative  atten- 
tion to  a  given  subject.  Fifteen  minutes  is  about  the 
limit  for  a  child  between  five  and  seven  years  of  age 


Period  of 
Weak  Heart 


Limit  of 
Attention 


170 


CARE  OF  CHILDREN 


Eye  and  Ear 

Strain 


and  the  grammar  school  pupils  rarely  show  a  ca- 
pacity for  more  than  thirty  minutes  of  uninterrupted 
study.  This  power  may  be  even  further  reduced  by 
debilitating  conditions,  such  as  improper  food,  im- 
paired digestion,  physical  fatigue,  insufficient  sleep  or 
vitiated  air  of  the  school  room. 

6       ?      8       9      io  •  u      12     13    14      15     16     YEAS 


Krohn's  Diagram  Representing  Relative  Time  of  Fatigue 
at  Different  Ages. 

Early  exhaustion  of  nerve  force  is  frequently  in- 
creased by  eye  strain  from  defective  vision  and  pupils 
often  appear  dull  at  school  because  they  can  not  see 
distinctly  maps,  charts  or  blackboard  exercises.  In 
the  same  category  as  a  cause  of  apparent  mental  dull- 
ness is  defective  hearing, — the  words  of  the  teacher 
failing  to  make  a  definite  impression  upon  the  child's 
sensorium,  with  resultant  confusion  of  ideas.  In  this 
respect  a  grave  responsibility  rests  upon  parents  and 
teachers.     The  oculist  and  aurist  should  be  frequently 


PUBESCENCE  171 

consulted  and  any  defects  in  these  "avenues  to  the 
mind"  corrected. 

The  subject  of  school -room  hygiene  is  too  broad  to  school 
receive  more  than  passing  .mention  here.  The  parent 
should  visit  the  schools  and  satisfy  himself  as  to  the 
heating  and  ventilation  of  the  rooms  in  which  his  chil- 
dren spend  so  many  hours.  The  seating  with  refer- 
ence to  light  and  vision,  adaptation  of  seat  and  desk 
to  the  size  of  the  child  so  that  undue  fatigue  or  actual 
deformity  may  be  obviated,  should  also  be  given  con- 
sideration. Is  there  a  judicious  alternation  between 
mental  concentration  and  free-limbed  exercise  suitable 
to  the  child's  age? 

PUBESCENCE 

Pubescence  is  a  period  of  the  greatest  importance  in 
the  development  of  the  child,  not  only  physically  but 
mentally  and  morally. 

The  rounding  out  of  the  girl's  physique  with  broad-  Changes 
ening  of  the  hips  and  rapid  growth  of  the  breasts  sug-  Girl 
gests  the  approach  of  menstral  function.  This  should 
never  be  allowed  to  take  the  little  maiden  by  surprise, 
but  the  mother  should  have  prepared  her  daughter's 
mind  for  this  sign  of  womanhood.  Unfortunate  is  the 
girl  whose  mother  has  not  had  the  tact  and  courage  to 
instruct  her  beforehand  concerning  the  true  meaning 
of  conception,  gestation  and  motherhood.  Many  lives 
have  been  lost  or  ruined  because  the  mother  has  failed 
in  her  duty  in  this  respect. 

Probably  the  best  argument  for  the  early  study  of 


172  CARE  OF  CHILDREN 

biology,  including  botany,  is  the  natural  introduction 
thus  afforded  to  the  great  mysteries  of  ovulation,  fruc- 
tification, conception,  gestation  and  parturition  and  the 
true  physical  relation  of  the  sexes  in  the  great  plan  of 
life.  There  is  nothing  to  shock  the  modesty  of  the 
normal  girl  if  these  subjects  are  properly  approached 
along  the  lines  of  comparative  biology. 
Care  The  pubescent  girl's  periodical  indisposition  should 
be  recognized  and  guarded  from  undue  burdens  and 
responsibilities,  as  the  foundation  for  future  suffering 
and  disease  is  often  laid  at  this  time.  The  woman  is 
fortunate  whose  pubescent  life  escaped  the  crippling 
effect  of  tight  or  high-heeled  shoes,  whose  anatomy 
has  not  been  distorted  and  generative  organs  disar- 
ranged by  the  corset,  and  whose  moral  and  social  edu- 
cation has  followed  natural  family  and  domestic  lines 
rather  than  the  artificialities  of  the  so-called  modern 
society. 

Wholesome  companions  and  literature,  out-of-door 
exercises  and  amusements  with  reasonable  domestic 
responsibilities  should  alternate  with  judicious  selec- 
tion of  musical,  physical  and  literary  curriculum  in 
well-selected  schools. 

The  judicious  parent  will  endeavor  to  teach  the  pu- 
bescent boy  manliness  rather  than  mannishness,  and 
to  inculcate  early  reverence  and  respect  for  pure 
womanhood.  He  should  have  the  companionship  of 
pure-minded  girls. 
The  Boy         The  boy  ought  to  be  taught  by  a  senior  whom  he  re- 


PUBESCENCE 


173 


veres  (preferably  his  father)  the  true  meaning  of  sex 
differentiation  and  sexual  passion.  It  should  be  clearly 
shown  him  that  venereal  disease  with  its  far-reaching 
baneful  effects  lurks  ever  as  the  penalty  for  licentious- 
ness. He  should  be  given  to  understand  that  an  oc- 
casional seminal  emission  while  sleeping  is  no  more 
sinful  than  a  transient  hemorrhage  from  overcharged 
blood  vessels  or  vomiting  for  an  overloaded  stomach. 
Above  all,  he  should  be  taught  to  respect  his  own 
body. 

Here  again  competitive  athletic  sports,  good  litera- 
ture, the  study  of  natural  sciences  with  abundance  of 
out-door  life  will  lead  the  boy  away  from  tendencies 
toward  immorality  and  dissipation. 

Close  confinement  to  books  and  literature  too  fre- 
quently causes  physical  and  mental  collapse  during 
pubescence,  for  which  the  prizes  for  scholarship  are 
not  infrequently  responsible.  Plenty  of  fresh  air  both 
day  and  night  and  the  daily  cold  bath  are  items  of  tre- 
mendous value  in  the  hygiene  of  pubescence.  Empha- 
sis and  encouragement  to  physical  development  should 
be  given  by  the  parent  at  this  time  (and  at  all  times). 
Better  take  the  boy  or  girl  out  of  school  for  a  term  or 
two,  if  necessary,  than  to  harm  his  body  for  life.  Book 
learning  can  easily  be  made  up,  but  perverted  physical 
development  often  can  never  be  rectified. 


Physical 
Development 
Moat 
Important 


174-  CARE  OF  CHILDREN 

BIBLIOGRAPHY 
\ 

Care  of  the  Baby  ($1.50,  postage  .18).     J.  P.  Crozer  Griffith, 

M.  D. 
Care  of  a  Child  in  Health  ($1.25,  postage  .12).   N.  Oppenheim, 

M.  D. 
Care  and  Feeding  of  Children  ($.75,  postage  .08)."  L.  E.  Holt, 

M.  D. 
Century  Book  for  Mothers  ($2.00,  postage  .18).   Yale  and  Pol- 
lock. 
Development  of  the  Child  ($1.25,  postage  .12).    N.  Oppenheim, 

M.  D. 
Hygiene  of  the  Nursery  ($1.00,  postage  .08).     Louis  Starr. 
Theory  and  Practice  of  Infant  Feeding  ($2.25,  postage  .20). 

Henry  Dwight  Chapin,  M.  D. 
Food  and  Principles  of  Dietetics   ($3.00,  postage  .26).     Robt. 

Hutchison,  M.  D.     Chapters  24,  25,  26. 
School  Hygiene  (For  teachers)   ($1.00,  postage  .10).     Edward 

R.  Shaw. 

Medical   Books 
Diseases  of  Children  ($3.50).     A.  C.  Cotton,  M.  D. 
Pediatrics — Hygiene    and     Medical     Treatment     of    Children 

($6.00).     T.  M.  Rotch,  M.  D. 
Diseases  of  Infancy  and  Childhood  ($6.00).    L.  E.  Holt,  M.  D. 


TEST  QUESTIONS 

The  following  questions  constitute  the  "written  reci- 
tation" which  the  regular  members  of  the  A.  S.  H.  E. 
answer  in  writing  and  send  in  for  the  correction  and 
comment  of  the  instructor.  They  are  intended  to 
emphasize  and  fix  in  the  memory  the  most  important 
points  in  the  lesson. 


CARE  OF  CHILDREN 

PART  111 

Read  Carefully.  Place  your  name  and  address  on  the  first 
sheet  of  the  test.  Use  a  light  grade  of  paper  and  write  on 
one  side  of  the  sheet  only.  Leave  space  between  the  answers 
for  the  notes  of  the  instructor.  Answer  every  question  fully. 
Read  the  lesson  paper  a  number  of  times  before  attempting 
to  answer  the  questions. 

1.  Does  crying  benefit  the  baby?     If  so,  how? 

2.  Describe  different  cries  and  give  their  interpre- 

tation. 

3.  What  do  you  understand  by  nervousness  in  a 

child? 

4.  Name  some  causes   for  nervousness    and   the 

symptoms. 

5.  (a)  What  does  fever  indicate  in  an  infant? 
(b)  What  may  be  done  for  its  relief? 

6.  (a)   What  is  an  ordinary  cold? 
(b)  Why  is  no  cold  trivial? 

7.  Give  the  cause  of  sore  throat. 

8.  (a)  What  is  the  "anarchist's  den"? 
(b)  How  may  it  be  cared  for? 

9.  What  contagious  diseases  are  the  most  danger- 

ous and  why? 

10.  Mention  the  possible  after  effects  of  measles. 

of  scarlet  fever. 

11.  What  causes  convulsions?     Why  are  they  to 

be  dreaded? 

12.  What  should  be  done  for  their  immediate  re- 

lief?    What  for  their  prevention? 


CARE  OF  CHILDREN 

13.  Mention  two  important  items  in  the  care  of 
whooping  cough? 

14.  Why  should  a  physician  be  called  immediately 
in  a  case  of  suspected  contagious  disease? 

15.  How  may  scurvy  be  prevented? 

16.  What  is  rachitis?    How  may  it  be  prevented? 

17.  What  are  the  dangers  of  a  discharging  ear? 

18.  How  would  you  guard  the  baby  against  sum- 
mer complaint? 

19.  What  can  you  say  as  to  treatment  for  consti- 
pation ? 

20.  What  is  the  aim  of  education? 

21.  What  to  you  are  the  most  important  points  in 
the  hygiene  of  the  school  child  ? 

22.  Pubescence, — what  does  it  mean  in  the  life  of 
the  boy  and  girl  ? 

23.  What  questions  have  you  to  ask? 

Note — After  completing  the  test,  sign  your  full  name 


SODIUM  CITRATE  IN  INFANT  FEEDING  * 

By  A.  C.  Cotton,  M.  D. 

The  infant  deprived  of  the  breast  must,  in  relation 
to  his  feeding,  be  regarded  as  a  pathologic  problem. 
That  this  statement  is  axiomatic  is  shown  by  the  fact 
that  more  earnest  work  has  been  bestowed  on  infant 
feeding  during  the  past  twenty  years  than  on  all  other 
pediatric  subjects  combined.  That  the  problem  is 
still  unsolved  the  high  relative  mortality  and  later 
morbidity  (illness)  of  artificially  fed  infants  bear 
constant  witness. 

The  six  essentials  of  Cheadle,  enunciated  by  that 
observer  some  time  in  the  '8o's,  bear  witness  that  the 
essential  requirements  of  an  artificial  food  for  babies 
were  broadly  understood  twenty  years  ago.  Quoting 
from  memory,  they  are  briefly  as  follows:  i.  Steril- 
ity. 2.  Antiscorbutic  property.  3.  Quantity.  4. 
Some  Animal  constituents.  5.  Form  suitable.  6. 
Constituency.  Much  has  been  learned  since  Cheadle 
by  amassing  clinical  results  and  observations.  Mean- 
while the  deductions  from  a  priori  reasoning  have 
proven  unsatisfactory  for  the  simple  reason  that  so 
little  was  known  of  the  physiology  of  infant  digestion. 
Latterly  the  premises  from  which  we  reasoned  have 
been  proven,  almost  without  exception,  to  be  incor- 
rect. 

*  Read  in  the  Section  on  Diseases  of  Children  of  the  American  Medical 
Association,  at  the  Fifty-seventh  Annual  Session,  June,  1906.  Reprinted 
from  the  Journal  of  the  American  Medical  Association  of  October  6,  1906. 

179 


180  CARE  OF  CHILDREN 

Thus  the  great  American  experiment  known  as 
the  exact  percentage  method  of  feeding  required 
that  the  baby's  diet  should  consist  wholly  of  cow 
products  and  water,  so  modified  in  its  five  gross 
constituents  as  to  coincide  quantitatively  with  simi- 
larly named  constituents  of  average  breast  milk. 
One  other  ingredient  only  was  allowable  in  this 
feeding  mixture,  viz.,  some  alkalin  solution,  as  lime 
water,  sodium  bicarbonate,  or  magnesia.  This  dogma, 
which  in  connection  with  laboratories  established 
throughout  the  country  had  almost  become  a  cult 
in  infant  feeding,  was  practically  based  on  seven 
assumptions,  which  have  recently  been  proven 
erroneous,  to  wit: 

i.  The  qualitative  similarity  in  breast  and  cow's 
milk  of  the  lactose,  fats,  albuminoids,  proteids  and 
their  chemical  combination  with  the  milk  salts. 

2.  The  claimed  alkalinity  of  breast  milk  in  contra- 
distinction to  the  acidity  of  cow's  milk. 

3.  The  possibility  of  a  synthetical  substitute  for 
breast  milk  from  cow  products  alone. 

4.  The  claim  that  cereals  were  not  allowable 
because  indigestible  in  the  infant's  secretions  and 
that  they  induced  dyspepsia  and  intoxication  by 
acting  as  decomposing  foreign  matter. 

5.  That  cereal  gruels  were  no  more  efficient  in  the 
prevention  of  dense  milk  coagula  than  dilution  with 
plain  water. 

6.  That  HC1  played  no  part  in  the  digestive  process 
until  later  infancy. 


SODIUM  CITRA  TE  IN  INFANT  FEEDING     181 

7 .  That  the  important  proteid  content  of  the  baby 's 
food  could  be  made  up  from  the  non-coagulable  whey 
albumin  of  cow's  milk. 

The  elucidation  of  facts  in  refutation  of  these  prem- 
ises is  due  to  the  earnest  work  of  a  number  of  men, 
prominent  among  whom  as  members  of  this  associa- 
tion may  be  mentioned  Chapin  on  cereal  gruels  and 
gastric  development,  Kerley  on  milk  reaction  and 
alkalinization,  Shaw  on  HC1  secretion  in  infants, 
Stern  on  milk  fats,  Southworth  on  the  art  versus  the 
science  of  infant  feeding,  Morse  on  acidified  milk  and 
buttermilk  feeding,  and  the  recent  unsurpassed  work 
in  chemistry  of  milk  by  Van  Slyke  and  Hart  at 
Geneva.  Most  of  these  contributions  have  enriched 
our  literature  and  become  familiar  to  all.  The 
subject  is  still  a  broad  one.  I  disclaim  any  intention 
of  attempting  in  this  limited  paper  to  deal  with  it  in 
toto,  and  indulge  in  these  preliminary  observations 
merely  to  emphasize  the  fact  that  no  royal  road  to 
successful  feeding  by  exact  mathematical  formulas 
has  yet  been  found.  Nor  do  I  wish  to  convey  the 
impression  that  I  would  belittle  the  value  of  attempts 
at  accuracy  in  determining  the  component  parts  of 
the  infant's  dietary. 

Great  credit  is  due  and  will  ever  be  associated  with 
the  name  of  Dr.  Rotch  as  the  founder  of  a  system 
which  has  not  only  served  as  a  hypothesis  for  tenta- 
tive feeding,  but  has  stimulated  to  greater  accuracy 
and  more  careful  clinical  observation  and  recording 
of  results  than  was  possible  by  any  other  method. 


1 82  CARE  OF  CHILDREN 

As  an  enthusiastic  advocate  of  the  so-called  American 
method,  I  am  on  record  frequently  both  at  home 
and  abroad.  I  may  be  pardoned  if  I  suggest  that  the 
tendency  in  general  is  too  much  along  the  line  of  the 
refinement  of  mathematical  formulas  to  the  neglect 
of  the  obvious  importance  of  gastric  development 
along  normal  physiologic  lines. 

The  spectacle  of  a  marantic  infant  with  persistent 
curds  in  the  stools,  though  cow  proteids  have  been 
reduced  to  the  extreme  limit  of  attenuation  by  dilu- 
tion with  water,  is  a  familiar  one.  So,  also,  too 
commonly  in  evidence  is  the  child,  fed  long  but  not 
nourished,  on  whey  proteids  and  cream,  whose  gastric 
vigor  has  not  progressed  beyond  that  of  early  infancy. 

Important  as  the  role  of  carbohydrates  and  fats  in 
infant  development  may  be,  and  difficult  as  the  pro- 
blem of  properly  dealing  with  fats  is,  it  is  to  the 
management  of  the  proteids  that  I  beg  to  call  your 
attention  in  the  few  minutes  allowed.  Their  impor- 
tance in  the  nutrition  of  the  child  needs  no  emphasis, 
as  it  is  universally  accepted  both  theroetically  and 
clinically. 

The  intolerance  of  the  infant's  digestive  organs  to 
cow  proteids,  so  widely  different  from  those  for  which 
they  were  intended,  is  also  well  known.  Of  the  many 
methods  in  vogue  for  the  establishment  of  toleration  of 
these  refractory  curds  the  one  most  common,  unfor- 
tunately, is  their  quantitative  reduction  by  dilution 
far  below  percentages  absolutely  necessary  for  the 


SODIUM  CITRA  TE  IN  INFANT  FEEDING     183 

development  and  growth  of  the  child.  In  fact,  the 
common  advice  to  infant  feeders  on  percentages  of 
milk  in  recognition  of  its  refractoriness,  is  either  to 
restrict  the  proteid  percentage  far  below  that  which  is 
known  to  obtain  in  average  breast  milk  (as  though 
Nature  would  commit  the  absurdity  of  elaborating 
the  necessary  amount  of  proteid  from  even  a  less 
quantity  when  presented  in  the  more  obstinate  form 
of  cow  casein),  or  to  substitute  the  non-coagulable 
proteids  of  whey. 

In  either  case  Nature  is  cheated  of  her  absolute 
demands.  The  pathetic  malnutritional  results  of 
low  proteid  feeding,  both  immediate  and  remote,  are 
too  familiar  to  us  all  to  need  further  elaboration. 
Aside  from  this  slow  starvation  and  stunted  growth 
with  its  diminished  resistance  to  intercurrent  disease 
from  insufficiency  of  nitrogenous  food,  abundance  of 
proteids  is  demanded  in  a  coagulable  form  for  the  nor- 
mal development  of  the  gastric  function,  as  ably 
shown  by  Chapin  and  corroborated  by  a  host  of  clini- 
cal observers.  This  the  infant  gets  at  the  mother's 
breast  in  proteids  which  clot  on  admixture  with  the 
gastric  contents  in  soft,  flocculent,  semi-solid  coagula 
which  readily  pass  the  pylorus  in  a  form  suitable  to 
intestinal  digestion  and  absorption. 

The  important  question,  then,  in  feeding  cow's 
milk  is  not  how  to  reduce  the  proteids  and  sustain 
life,  but  how  to  increase  the  proteids  and  maintain 
unimpaired   digestion.     Buttermilk   has   been    tried: 


1 84  CARE  OE  CHILDREN 

acidulated  milk  has  been  tried;  admixture  with 
gruels  has  been  tried;  koumiss,  matzoon,  and  kephir 
milk  have  been  tried;  the  addition  of  various  alka- 
lies is  much  in  vogue;  all  with  varying  degrees  of 
success,  and  each  measure  has  its  ardent  advocates. 
That  the  question  is  not  yet  settled  this  diversity  of 
opinion  amply  indicates.  It  is  still  an  open  field,  and 
the  cry  that  no  chemical  tampering  with  the  milk 
should  be  encouraged  need  deter  no  one,  since  it  is 
proven  beyond  dispute  that  cow's  milk,  however 
modified,  is  not  a  natural  food  for  the  human  infant. 
The  more  orthodox  observers  of  the  original  labora- 
tory percentage  modification  have  from  the  first 
chemically  tampered  with  the  milk  in  the  addition  of 
lime  water,  sodium  bicarbonate,  etc.,  in  the  mistaken 
notion  of  humanizing  the  mixture  by  rendering  it 
alkalin.  That  we  reached  further  than  we  intended 
in  our  administration  of  alkalies  and  secured  tolera- 
tion of  the  curds  through  neutralization  of  the  normal 
gastric  acids  does  not  lessen  the  evils  of  inhibition 
of  those  digestive  processes  which  can  occur  only  in  an 
acid  medium. 

Since  deductive  methods  from  a  priori  reasoning 
have  thus  far  failed  of  a  satisfactory  solution  of  this 
problem,  let  us  welcome  inductive  methods  conducted 
along  rational  lines,  since  massed  clinical  evidence 
must  ever  be  the  tribunal  before  which  all  method 
must  come  to  trial.  Whether  secundus  artem  or 
secundus  scientiam,  it  is  the  greatest  number  of  babies 


SODIUM  CITRA  TE  IN  INFANT  FEEDING     185 

who  live  and  thrive  and  resist  disease  that  demon- 
strates the  merits  of  their  hygiene. 

It  is  with  the  firm  conviction  that  sodium  citrate, 
through  its  inhibition  (prevention)  of  dense  coagula- 
tion of  cow's  milk  in  the  presence  of  an  acid  and 
rennin,  may  prove  valuable  in  the  solution  of  the 
proteid  problem  that  I  present  a  brief  resume"  of  my 
experience  with  this  agent. 

More  than  two  years  ago  in  a  personal  letter  from 
one  of  my  assistants,  Dr.  J.  W.  Vanderslice,  who  was 
studying  abroad,  my  attention  was  called  to  this 
use  of  sodium  citrate.  The  reports  from  Dr.  F.  J. 
Poynton's  clinic  at  Great  Ormond  Street,  London, 
from  which  the  writer  as  an  eye  witness  drew  his  con- 
clusions, seemed  sufficient  to  justify  a  careful  con- 
sideration of  this  new  method  of  overcoming  some 
of  the  obstacles  in  the  adaptation  of  cow's  porteids 
to  infant  digestion. 

Rather  cautiously,  I  began  prescribing  the  citrate 
in  cases  in  which  varying  milk  mixtures  had  been 
used  with  poor  success.  Later,  as  I  found  that 
infants  would  tolerate  a  larger  proportion  of  the  milk 
in  the  feeding  mixture  when  citrated,  than  by  any 
other  modification  known  to  me,  I  used  it  more  boldly, 
so  that  during  the  past  two  years  I  find  a  record  of  its 
employment  for  a  longer  or  shorter  period  in  more 
than  50  cases  in  both  hospital  and  private  practice. 
I  have  here,  by  the  courtesy  of  Dr.  J.  D.  Merrill,  a 
report  of  8  cases  in  which  she  has  carefully  observed 


1 86  CARE  OF  CHILDREN 

its  effects  for  a  considerable  time,  also,  by  the  courtesy 
of  Dr.  Vanderslice,  a  history  of  29  cases  reported  by 
him  at  different  times  to  the  Chicago  Pediatric  Society. 
In  addition  to  this  I  have  read  carefully  Dr.  Shaw's 
report  of  22  cases,  making  a  total  of  1 12  cases  embrac- 
ing nearly  all  conditions  from  simple  dyspepsia  to 
marasmus  and  ranging  in  age  from  the  new  born  to 
adults  who  have  suffered  from  milk  dyspepsia. 

Sodium  citrate  being  very  soluble  in  water,  the 
method  of  employment  is  simple,  as  follows:  An 
aqueous  solution  is  ordered  containing  from  1  to  5  gr. 
to  the  dram.  A  quantity  of  this  solution  is  furnished 
the  mother  or  nurse  with  instructions  to  add  to  the 
baby's  bottle  immediately  before  feeding  enough  of  the 
solution  to  represent  1,  2,  or  even  3  gr.  of  the  citrate 
to  each  ounce  of  milk  in  the  feeding  mixture,  accord- 
ing to  the  prescriber's  idea  of  the  requirements.  The 
feeding  mixture  may  consist  of  varying  dilutions  of 
milk  with  water  or  gruel,  with  the  addition  of  cane  or 
milk  sugar,  with  or  without  cream.  No  alkalies  are 
added ,  the  sodium  citrate  used  being  a  neutral  salt.  A 
most  noticeable  feature  in  this  method  of  feeding  is  the 
large  proportion  of  milk  in  the  feeding  mixture  that 
the  infant  will  tolerate  without  evidence  of  gastric 
disturbance  or  the  appearance  of  any  considerable 
amount  of  undigested  casein  in  the  stools.  In  fact, 
the  stools  of  babies  fed  on  citrated  milk  have  come 
to  be  regarded  by  Drs.  Merrill,  Vanderslice,  and 
myself  as  positively  characteristic,  being  firm  enough 


SODIUM  CITRA  TE  IN  INFANT  FEEDING     187 

to  show  form  on  the  diaper,  free  from  fecal  odor,  and 
homogeneous  in  color  and  consistency.  The  slight 
tendency  to  constipation  mentioned  by  Dr.  Vander- 
slice  I  have  observed  in  a  number  of  cases.  This  I 
attributed  to  the  low  percentage  of  fat  in  the  food 
consisting  of  equal  parts  of  milk  and  water  or  even 
one  part  of  milk  to  two  of  water.  In  but  few  instances 
have  I  observed  this  constipation  where  the  fat 
content  of  the  mixture  equaled  3  per  cent. 

One  indication  for  the  increase  of  the  sodium 
citrate,  even  in  some  cases  to  as  high  as  3  gr.  to  the 
ounce  of  milk,  is  vomiting  of  curds.  Another  indica- 
tion is  the  appearance  of  curds  in  the  stools,  care 
being  taken  to  exclude  indigestion  from  excess  or 
intolerance  of  fats.  Of  the  stools,  J.  H.  Salisbury, 
professor  of  chemistry,  to  whom  they  were  submitted, 
reports  as  follows: 

Three  samples  of  the  feces  of  infants  fed  with  milk  modi- 
fied by  the  addition  of  citrate  of  sodium  were  examined. 
The  feces  were  yelloV,  of  a  moderately  firm  consistence  and 
remarkably  homogeneous.  On  microscopic  examination  a 
few  round  masses,  probably  calcium  soaps,  could  be  seen 
scattered  through  the  otherwise  very  fine  debris.  In  two 
specimens  short  crystals  of  soap  could  be  detected.  No 
free  fat  was  found.  On  treatment  with  acetic  acid  more 
or  less  acid  crystals  could  be  observed  and  in  one  specimen 
this  was  especially  marked.  Chemical  examination  of  one 
specimen  for  proteids  was  negative. 

The  duration  of  the  administration  of  the  sodium 
citrate,  as  well  as  the  quantity  employed,  varies  con- 
siderably in  different  cases,   the  purpose  being  to 


188  CARE  OF  CHILDREN 

bring  the  baby's  feeding  up  toward  whole  milk  as 
rapidly  as  possible.  As  toleration  is  established  the 
amount  of  citrate  is  reduced  to  one,  to  one  half  and  to 
one  fourth  of  a  grain  per  ounce  of  milk  until  it  can  be 
discontinued.  It  happens  not  infrequently  that  the 
citrate  is  profitably  resumed  on  the  recurrence  of 
signs  of  indigestion.  In  but  6  cases  have  I  felt 
obliged  to  discontinue  the  citrated  milk  and  adopt 
other  methods  of  feeding.  Some  of  these  were  among 
my  early  cases  which,  if  occurring  later,  would  pos- 
sibly have  received  a  more  persistent  treatment  with 
citrated  milk. 

In  consideration  of  this  subject  three  questions 
naturally  arise:  i.  Is  the  employment  of  sodium 
citrate  any  better  than  other  methods  of  rendering 
cow  proteids  tolerable  and  digestible  ?  2 .  Is  its 
employment  harmful?  3.  In  what  manner  does 
it  act? 

In  answer  to  the  first  I  would  say  that  this  method 
seems  to  allow  a  more  rapid  increase  in  the  propor- 
tion of  milk  ingested  than  any  other  known  to  me. 
Moreover,  the  frequency  of  relief  from  milk  indi- 
gestion on  the  addition  of  the  citrate  and  the  favor- 
able reports  from  all  whom  I  have  known  to  give 
it  a  thorough  trial  are  not  without  significance. 
In  regard  to  its  harmfulness,  no  case  of  citrated 
milk  feeding  has  been  brought  to  my  attention  in 
which  there  appeared  to  be  cause  for  regret  because 
of  the  employment  of  this  method. 


SODIUM  CITRA  TE  IN  INFANT  FEEDING     189 

Concerning  its  manner  of  action  in  a  chemical 
sense,  there  appears  to  be  some  difference  of  opinion. 
Professor  Salisbury,  above  quoted,  to  whom  the 
question  was  submitted,  states  as  follows: 

Citrate  of  calcium  is  insoluble  in  water,  but  dissolves  readily 
in  solutions  of  the  alkali  citrates.  It  is  to  be  presumed, 
therefore,  that  when  a  solution  of  sodium  citrate  is  added 
to  milk,  which  contains  calcium  in  combination  with  casein, 
a  reaction  would  occur  producing  a  sodium  combination 
of  casein  and  an  insoluble  calcium  citrate.  The  latter 
would  dissolve  on  the  addition  of  an  excess  of  sodium  citrate. 
It  is  to  be  presumed,  therefore,  that  the  milk  treated  with 
citrate  of  sodium  contains  a  sodium  compound  of  casein 
and  calcium  citrate  held  in  solution  by  the  presence  of  sodium 
citrate.  Such  milk  would  not  yield  a  curd  containing  an 
excess  of  calcium,  but  the  calcium  would  be  found  in  the  whey 
as  well  as  in  the  curd.  The  experiments  of  Dr.  R.  Aibinder 
do  not  contradict  the  theory  of  Poynton  that  sodium  citrate 
acts  by  separating  the  calcium  from  the  casein,  thus  render- 
ing it  less  easily  coagulable.  Sodium  citrate  would  react 
with  hydrochloric  acid  solution  to  form  sodium  chlorid  and 
citric  acid.  The  decomposition  would  not  be  complete  but 
so  nearly  so  that  a  large  quantity  of  sodium  citrate  would 
neutralize  nearly  all  the  free  hydrochloric  acid  of  the  gastric 
juice.  Too  large  an  amount  of  sodium  citrate  in  the  milk 
might,  therefore,  interfere  with  the  digestion  of  proteids 
in  the  stomach.  Such  digestion  might  occur  in  the  intestine 
from  the  action  of  the  pancreatic  juice. 

The  physical  behavior  of  citrated  milk  in  vitro, 
outside  the  body,  is  obvious  and  may  be  demonstrated 
in  a  simple  manner  suggested  by  Wright  and  Poyn- 
ton, who  first  exploited  this  method  of  feeding.  Into 
each  of  two  test  tubes  containing  equal  quantities  of 


I  go  CARE  OF  CHILDREN 

milk  (to  one  of  which  sodium  citrate  has  been  added) 
drop  a  given  quantity  of  liquid  rennet  and  dilute 
hydrochloric  acid.  In  both  milks  coagulation  occurs, 
with  this  difference,  that  the  citrated  milk  clots  less 
promptly  and  the  resultant  curd  is  softer,  less  dense, 
more  nearly  resembling  the  curd  of  breast  milk. 

My  assistant,  Dr.  F.  W.  Allin,  as  the  result  of  more 
than  a  hundred  careful  comparisons,  has  obtained 
the  following  results: 

Materials  Used. — Ordinary  dairy  milk  was  used 
in  these  experiments.  Wyeth's  liquid  rennet  was 
used  for  curdling  agent,  which  was  always  added 
last.  A  i  per  cent  hydrochloric  acid  solution  and 
4  per  cent  sodium  citrate  solution  were  used.  Two 
drops  of  HC1  in  5  c.c.  milk  equals  .025  per  cent. 
Five  drops  of  sodium  citrate  solution  equals  .25  per 
cent.  One  grain  of  sodium  citrate  to  the  ounce  of 
milk  would  be  .20  per  cent.  The  gruels  were  stand- 
ardized to  one  ounce  of  flour  or  oatmeal  to  the  quart 
of  water  and  cooked  three  hours  in  a  double  boiler. 

Conditions. — The  experiments  were  all  performed 
at  40  C.  in  glass  test  tubes.  The  milk  was  used  as 
whole  milk  or  diluted  with  water,  flour  gruel,  or  oat- 
meal gruel.  The  dilutions  made  were  two  thirds, 
one  half,  one  third,  one  fourth,  one  eighth  milk. 

$    *    *    *     *     *     * 

CONCLUSIONS 

i.  Sodium  citrate  in  25  per  cent,  or  more,  retards, 
and  very  high  percentages  will  inhibit  coagulation. 


SODIUM  CITRA  TE  IN  INFANT  FEEDING     igi 

2.  The  presence  of  HC1  hastens  coagulation. 

3.  Diluting   milk   generally   retards   coagulation. 

4.  Gruels  appear  to  have  little  or  no  effect  in 
retarding  coagulation  more  than  water  when  the 
the  citrate  is  used. 

5.  The  coagula  of  citrated  milk  are  softer,  smooth- 
er, and  more  jelly-like  or  more  flocculent  than  those 
of  milk  not  thus  treated. 

The  simplicity  of  this  method  commends  itself, 
especially  in  dispensary  and  out-patient  practice, 
where  the  mother's  demand  for  "medicine"  for  the 
baby's  dyspepsia  may  be  met  by  the  standard  solu- 
tion of  sodium  citrate  to  be  administered  in  teaspoon- 
ful  dose  in  each  bottle  of  the  feeding  mixture.  In 
private  practice  it  furnishes  another  rational  method 
of  infant  feeding. 

1485  Jackson  Boulevard,  Chicago. 

Editor's  Note.  This  article,  intended  for  physicians,  is 
included  here  only  to  inform  mothers  and  nurses  of  the 
latest  and  seemingly,  a  very  important  development  in  the 
artificial  feeding  of  infants.  It  is  obvious  that  this  new 
method  should  be  tried  only  under  the  direction  of  the  at- 
tending physician. 

Sodium  citrate  is  made  by  neutralizing  citric  acid  with 
soda  Citric  acid  is  the  acid  found  in  lemons,  oranges,  and 
some  other  fruits.  As  stated,  sodium  citrate  unites  with 
some  of  the  lime  (calcium)  compounds  which  make  the  clots 
of  cow's  milk  more  dense  than  those  of  mother's  milk. 


THE  SOOTHER* 

By  A.  C.  Cotton,  M.  D. 

In  these  days,  the  inalienable  right  of  a  child  to 
protection,  especially  during  the  helpless  period  of 
infancy,  no  thoughtful  physician  questions.  Even 
the  lay  mind  seems  to  have  grasped  the  idea  that 
the  infant  should  be  guarded  against  all  influences 
detrimental  to  his  normal  growth  and  development. 

It  is  well  recognized  that  one  of  the  commonest 
causes  of  infant  mortality  and  morbidity  is  to  be 
found  in  disturbances  of  the  digestive  tract.  That 
these  disturbances  are  commonly  due  to  infections 
is  generally  admitted.  Much  is  yet  to  be  learned 
in  regard  to  the  exact  nature  of  these  infections,  but 
all  observers  seem  to  agree  upon  two  principal 
sources  of  infection,  viz.,  exogenous  and  endogenous. 
In  the  majority  of  cases  of  gastro-intestinal  disturb- 
ance it  is  not  easy  to  differentiate  between  these  two 
sources.  The  term  "Autointoxication"  is  frequent- 
ly heard  as  an  explanation  of  gastro-enteric  infec- 
tion in  many  instances  in  which  the  source  of  the 
infective  material  is  in  doubt.  Enough  is  known 
however,  both  from  clinical  observation  and  bac- 
terial demonstration,  that  food  infection,  especially 
among  nurslings,  is  the  most  frequent  cause  of  their 
disorders;  hence  the  recent  revival  of  interest  in  the 

♦Reprinted  from  the  Medical  Brief,  September,  1904. 
192 


THE  SOOTHER  193 

milk  supply  and  methods  of  handling  the  same,  also  in 
the  means  of  protection  from  germs  which  might  prove 
detrimental  to  the  quality  of  the  milk  or  injurious 
to  the  digestive  apparatus  of  the  infant.  Pasteur- 
ization, and  even  sterilization,  though  undoubted- 
ly depreciating  the  food  value  of  the  milk  as  well  as 
its  digestibility,  are  advocated  by  many  who  would 
minimize  the  danger  from  the  introduction  of  path- 
ogenic micro-organisms  with  the  food.  For  the 
same  reason,  the  improved  hygiene,  including  the 
care  of  the  nursing  bottle,  the  sterilization  of  the  nip- 
ple, the  antiseptic  care  of  the  baby's  mouth,  and 
everything  pertaining  to  the  act  or  process  of  feed- 
ing, is  widely  practiced. 

The  unanimity  of  the  profession  in  regard  to  these 
details  leads  the  writer  to  call  attention  to  a  glaring 
inconsistency  in  infant  hygiene,  which  is  so  wide- 
spread as  to  come  under  the  daily  observation  of 
every  baby  feeder.  The  long-tube  nursing  bottle 
is  practically  obsolete;  indeed,  some  municipalities 
have  enacted  laws  against  the  sale  or  use,  for  the 
evident  reason  which  has  been  amply  demonstrated 
—  that  the  apparatus  can  not  be  kept  germ-free. 
Great  cedit  is  due  to  Doctor  Ernest  Mende,  of  Buffalo, 
for  his  vigorous  and  successful  crusade  against  this 
death-dealing  tube.  As  though  the  nursling  had  not 
enough  to  contend  with  in  securing  his  right  to 
protection  in  our  unhygienic  homes,  it  would  seem 


194  CARE  OF  CHILDREN 

that  saturnine  ingenuity  were  invoked  to  devise 
methods  to  introduce  pathogenic  micro-organisms 
into  his  very  vulnerable  digestive  tract. 

Such  an  ingenious  device  I  now  refer  to,  as  the 
"soother"  conspicuously  displayed  for  sale  at  all 
shops.  So  popular  with  the  laity  is  this  devilish 
invention  that  mothers  and  grandmothers  wantonly 
teach  the  baby  its  use,  and  have  been  known  to 
express  regret  when  the  infant  did  not  take  to  it 
kindly,  because  it  appeared  to  be  such  a  comforting 
habit  when  once  established. 

Upon  examination  of  the  construction  of  this  so- 
called  "soother"  and  its  method  of  employment,  it 
is  evident  that  no  apparatus  could  be  constructed 
to  furnish  a  better  medium  for  the  collection  and 
cultivation  of  a  great  variety  of  organisms,  many 
of  which  are  undoubtedly  pathogenic  to  the  nursling. 
Warmth  and  moisture  are  supplied  by  the  baby's 
mouth  and  secretions.  Germs,  everywhere  present, 
are  planted  upon  this  culture  bed  from  frequent 
contact  with  hands  and  garments  and  furniture, 
floor,  ground,  and  not  infrequently,  from  the  mouth 
of  the  mother  or  nurse.  The  contrivance  itself, 
with  its  adhesive,  retaining  surfaces,  its  constrictions 
and  ridges,  its  bone  shield  and  stem  with  their  crev- 
ices, depressions,  and  openings,  its  ornamental  ring 
with  fancy  ribbon  or  filthy  string  by  which  it  is 
attached  to  the  person  of  the  victim,  all  perform 
their  part    in    the    cultivation    and    colonization  of 


THE  SOOTHER  195 

possibly  death-dealing  microbes.  If  any  one  is 
inclined  to  question  the  truthfulness  of  these  state- 
ments, let  him  possess  himself  of  the  next  "  soother  " 
that  he  meets  in  active  operation,  and  examine 
smears  from  the  accumulations  in  its  grooves.  His 
microscope  and  cultures  will  convince  him  of  the 
truth  of   my  statement. 

Pernicious  as  it  may  be,  this  daily  and  hourly 
ingestion  of  infective  organisms  is  not  the  limit  of 
possible  injury  to  the  infant  through  means  of  the 
"soother."  The  subject  of  adenoid  facies,  so-called 
in  its  relation  to  the  existence  of  troublesome  aden- 
oids, has  not  escaped  the  attention  of  any  student 
of  child  development.  Peculiar  conformation  of  oral 
and  facial  structures  is  commonly — perhaps  too  com- 
monly— attributed  to  the  presence  of  the  adenoids. 
That  the  adenoid  face  frequently  appears  as  a 
familiar  type  is  well  known,  and  the  etiological 
relationship  of  the  malformation  to  the  nasopharyn- 
geal growths  is  a  question  not  yet  settled.  That 
the  adenoid  face  is  found  with  the  adenoids,  is  not 
proof  that  the  former  is  due  to  the  latter.  That 
adenoids  may  cause  mouth-breathing  is  evident. 
That  mouth-breathing  causes  well-known  deform- 
ities such  as  a  narrowing  of  the  palate,  constriction 
of  the  inferior  nasal  meati,  with  deflection  of  the 
nasal  septum,  is  not  so  apparent.  That  mere  in- 
spiration and  expiration  through  the  mouth  will 
cause,  or  even  greatly  influence  the  oro-nasal  con- 


1 96  CARE  OF  CHILDREN 

formation,  the  writer  does  not  believe,  though  he 
accepts  the  deformity  or  any  other  condition  which 
interferes  with  free  nasal  respiration  as  prolific  in  the 
causation  of  naso-pharyngeal  catarrhs,  with  hyper- 
trophy of  adenoid  tissue.  The  direct  current  in- 
spired in  the  mouth-breather  incites  tonsilar  hy- 
peremia and  hypertrophy,  so  that  the  familiar  type 
of  this  deformity  may  prove  the  starting  point  to 
the  lesions  of  the  mucosa  above  mentioned. 

In  the  absence  of  heredity  it  may  be  questioned 
whether  intrauterine  conditions  or  pressure  at  the 
time  of  delivery,  with  or  without  forceps,  may  not 
influence  the  peculiar  conformation  known  as  "con- 
genital adenoid  fades."  Be  that  as  it  may,  the 
fact  is  well  known  that  an  infant  apparently  normal 
at  birth  may  gradually  develop  this  oro-naso-facial 
deformity  between  the  sixth  month  and  the  third 
year  of  its  life.  The  not  uncommon  dental  deform- 
ity produced  by  thumb  sucking  has  been  thoroughly 
exploited.  Little,  however,  so  far  as  the  writer 
knows,  has  been  said  in  regard  to  the  effect  of  the 
continuous  use  of  the  "soother"  in  this  connection. 
When  we  recall  the  plastic  condition  of  the  structures 
that  make  up  the  oral  and  nasal  cavities,  giving  form 
to  the  infant  face,  and  remember  that  ossification 
is  incomplete  at  birth,  proceeding  only  from  numer- 
ous ossific  centers  with  intervening  areas  of  plastic 
tissue,  it  is  not  difficult  to  perceive  that  persistent, 


THE  SOOTHER  197 

or  continuously  remittent  pressure  applied  in  the 
same  direction  will  influence  the  shape  of  the  struc- 
ture as  ossification  proceeds.  The  modern  opera- 
tions for  congenital  bony  defects,  as  fissure  of  the 
palate,  shows  how  plastic  are  these  palatal  and  al- 
veolar structures  in  early  infancy.  The  normal 
oral  cavity  in  infancy  is  extremely  shallow.  The 
alveolar  ridges  are  low,  and  do  not  approximate 
when  the  mouth  is  closed,  in  which  position  the 
tongue  fills  the  entire  fossa,  pressing  lightly  against 
the  flat,  low-vaulted  palate. 

The  mother's  nipple,  conical  in  shape,  with  proxi- 
mal base,  very  compressible,  is  seized  in  the  act  of 
nursing  by  the  infant's  lips,  which  are  exceedingly 
prehensible  in  their  function,  the  anterior  alveolar 
ridges  being  employed  to  assist  the  suction  in  strip- 
ping the  nipple  from  base  to  apex.  The  milk;  which 
flows  freely  from  the  sympathetic  breast  in  response 
to  the  nervous  mechanism  of  the  mother,  is  thus 
easily  secured  with  but  little  effort  on  the  part  of 
the  child,  in  the  line  of  vacuum  formation.  To  be 
sure,  where  the  flow  is  meagre  or  refractory,  the 
vacuum-forming  apparatus  with  its  sucking  pads 
is  complete,  and  may  be  employed  with  great  energy. 
In  all  of  this,  however,  the  roof  of  the  mouth  is  dis- 
turbed by  little  or  no  pressure,  and  the  child,  grati- 
fied with  the  steady  flow  of  delicious  aliment,  finds 
but  little  need  for  suction  sufficient  to  cause  great 
lateral  pressure  on   the   alveolar  ridges.     Moreover 


198  CARE  OF  CHILDREN 

the  act  of  nursing  occupies  but  a  short  time,  and  is 
followed  by  hours  of  rest. 

The  "soother"  resembles  the  maternal  nipple 
in  no  respect.  Almost  without  exception  it  is  pear- 
shaped,  the  narrow  neck  emerging  from  a  disc  of 
bone,  which,  resting  against  the  outside  of  the  flat- 
tened lips,  prevents  the  apparatus  from  being  swal- 
lowed. This  pressure  does  away  with  the  prehensile 
function  of  the  lips.  The  large  foreign  body,  en- 
gaged between  the  tongue  and  the  yielding,  plastic 
roof  of  the  mouth,  is  mumbled  continuously,  while 
frantic  efforts  at  suction  to  derive  milk  from  this 
barren  apparatus  develop  the  mechanism  for  vacuum 
formation  to  the  highest  degree.  What  follows  ? 
The  powerful  buccal  muscles  with  their  sucking 
pads  are  continuously  forced  against  the  lateral 
alveolar  ridges.  The  upward  pressure  of  this  pear- 
shaped  body  increases  the  concavity  of  the  yielding 
palatal  arch,  thus  favoring  the  approximation  of 
the  superior  lateral  alveolar  ridges.  The  inferior 
nasal  meati,  whose  floor  is  thus  uplifted,  are  dimin- 
ished in  height.  The  septum  nari,  buckling  under 
pressure,  still  further  limits  the  respiratory  area  of 
the  nose.  Moreover,  the  use  of  the  "soother"  be- 
comes practically  continuous  as  the  habit  develops, 
so  that  the  mumbling  and  sucking  continues  even 
during  the  broken  slumber.  Indeed,  it  is  usually 
interrupted  only  long  enough  for  the  infant  to 
receive  food,  and  the  infernal  contrivance  to  receive 


THE  SOOTHER  loo 

fresh  smears  of  bacteria  from  the  never-failing 
environmental  supply.  It  is  doubtful  if  this  pro- 
lific agent  of  infection  and  deformity  will  ever  be 
entirely  abolished  without  legislation  prohibiting 
its  manufacture  and  sale. 
1485  Jackson  Boul  ,  Chicago 


SUPPLEMENTAL  PROGRAM  ARRANGED  FOR 
CLASSES  ON 

CARE  OF  CHILDREN 

MEETING  I 

(Study  pages  1-31) 
Before  Baby  Comes. 

Care   of   the   Child   in    Health,   Oppenheim,    pages    1-46. 

($1.25,  postage  12c.) 
Century  Book  for  Mothers,  Yale  and  Pollock,  pages  1-24. 

(§2. 00,  postage  18c.) 
Care  of  the  Baby,  Griffith,  pages  17-34.     (Si. 50,  postage 
18c.) 
The  New  Born  Baby  and  His  Care. 

Care  of  the  Baby,  pages  34-46;  Century  Book  for  Mother?., 
pages  25-29. 
Clothing. 

Century  Book  for  Mothers,  pages  44-58. 
Care  of  the  Baby,  pages  86-115. 
Exhibit. 

(1)  Make  pattern,  cut  and  finish  a  "  baby  bag,"  as  shown 
on  page  23.  Contrast  this  with  a  typical  pinning 
blanket. 

(2)  Show  simple  and  tasteful  baby's  dresses  and  over 
elaborate  dresses. 

(3)  Trace  the  outline  of  a  child's  bare  foot. 

(4)  Show  good  and  bad  shoes. 

MEETING  II 

(Study  pages  32-53) 
The  Nursery,  Sleep,  Bathing. 

Care  of  the  Baby,  pages  213-224,  68-85. 
Century  Book  for  Mothers,  pages  18-24. 


202  CARE  OF  CHILDREN 

See  article  on  The  Soother  in  the  Supplement. 
Development  and  Growth 

Century  Book  for  Mothers,  pages  59-76. 

Care  of  the  Baby,  pages  46-67. 

If  possible,  show  a  weight  chart  for  some  baby. 

(Select  answers  to  the  Test  Questions  on  Part  I  and  send 

them  to  the  School.     Report  on  supplemental  reading, 

etc.  for  the  first  two  meetings.) 

MEETING  III 

(Study  pages  55-75) 
Natural  Food. 

Food  and  Dietetics,  Hutchison,  pages  414-427.  (S3. 00, 
postage  26c.) 

Care  of  the  Baby,  Griffith,  pages  1 16-132. 

If  not  familiar  with  food  principles  and  their  use  in  the 
body,  read  Food  and  Dietetics,  Norton  (Volume  VI, 
Library  of  Home  Economics) ,  or  send  to  the  Department 
of  Agriculture,  Washington,  D.  C,  for  some  of  the  free 
bulletins  called  Farmers'  Bulletins:  No.  142,  Principles 
of  Nutrition  and  Nutritive  Value  of  Food;  No.  42, 
Facts  about  Milk;  No.  74,  Milk  as  Food;  No.  93,  Sugar 
as  Food;  No.  108,  Eggs  and  their  Use  as  Food,  etc. 

MEETING  IV 
(Study  pages  75-122) 
Artificial  Feeding 

Care  and  Feeding  of  Infants,  Holt.     (75c.  postage  6c.) 
Food  and  Dietetics,  Hutchison,  pages  428-453.     ($3.00. 

postage  26c.) 
See  article  in  the  Supplement  on  Citrate  of  Soda  in  Infant 

Feeding. 
See  Farmer's  Bulletin,  No.   210,  The  Covered  Milk  Pail; 

No.  227,  Clean  Milk. 
Have  a  report  on  the  local  milk  supply  as  to  sanitary  condi- 
tion of  dairies,  age  of  milk  when  delivered,  enforcement 
of  local  regulations. 


PROGRAM  203 

Visit  a  model  dairy. 

Send  for  the  booklets  of  the  manufacturers  of  the  various 

"  infant  foods."     Weigh  the  evidence. 
Food  for  the  Second -year  and  Older  Children. 

See  Food  and  Dietetics,  Norton  (Vol.  VI  of  the  Library) 

pages  174-178. 
How  to  Feed  Children,  Hogan.     ($1.00,  postage  10c.) 
(Send  in  answers  to  the  Test  Questions  on  Part  II  and  give 

a  report  of  Meetings  III  and  IV.) 

MEETING  V 

(Study  pages   123-164.) 
Food  Disorders. 

Care  and  Feeding  of  Infants,  Part  III. 
Century  Book  for  Mothers,  pages  124-135;  258-265. 
Minor  Troubles. 

Send  2  cent  stamp  to  the  State  Board  of  Health,   Spring- 
field, 111.,  for  their  bulletin  on  "Infant  Feeding." 
See    article   on    "Soothing    Syrups"    in    Collier's   Weekly, 

April  28,  1906. 
Century  Book  for  Mothers,  pages  193-218;  233-242. 
Children's  Diseases. 

Care  of  the  Baby,  pages  314-336. 

Send  to  the  State  Board  of  Health,  Lansing,  Michigan,  for 
their  bulletin  on  Diphtheria,  Scarlet  Fever,  Whooping 
Cough,  Measles,  Meningitis,  and  Teachers'  Bulletin  No. 
87,  "  The  Milk  Problem." 
Also  send  to  the  Secretary  of  your  own  State  Board  of 
Health  (to  the  capital  city)  for  any  bulletins  on  conta- 
gious diseases. 

MEETING  VI 
(Study  pages  165-173.) 
Hygiene  of  the  Child  and  Youth. 

Report  on  the  ventilation,  heating,  lighting,  and  sanitary 

care  of  local  schools. 
What  attention  is  given  to  physical  education. 


204  CARE  OF  CHILDREN 

Read  extracts  from  "  The  Medical  Inspection  of  Schools," 
Lewis  S.  Somers,  M.  D.  Prize  essay,  free  from  the  publish- 
ers, The  Maltine  Company,  Brooklyn,  N.  Y.  (6c.  of  the 
School.) 

(Send  answers  to  the  Text  Questions  on  Part  III  and  give 
a  report  of  Meetings  V  and  VI.) 


INDEX 


Abnormal  passages,  134 
Adenoids,  144 
Albumin  water,  1  20 
Anarchistic  den,  143 
Artificial  feeding,  76-114 
Attention,  limit  of,  169 
Baby  bag,  22 

bottle  fed,  11 1 

care  of,  15 

care  of  before  birth,  1 

clothes,  20 

needs  of,  1 7 

new  born,  6 
Bacteria  in  milk,  82 
Bands,  30 
Bare  legs,  31 
Bath,  bran,  38 

first,  17 

salt,  38 
Baths,  duration  of,  39 

frequency  of,  39 

temperature  of,  38 
Bathing,  38,  167 
Beef  tea,  119 
Bibliography,  174 
Bones,  condition  of,  1 1 
Bottle  fed  baby,  92,  111 
Brain,  development  of,  168 
Breasts,  care  of  mother's,  4 
Breathing,  12,  124 

deep,  166 
Capacity  of  stomach,  46 
Care  in  dressing  baby,  27 

of  baby  before  birth,  1 

of  mother,  1,  70 

of  new  baby,  1 5 

of  nose,  144,  166 

of  scalp,  19 

of  teeth,  165 


Care  of  throat,  166 

Catarrh,  141 

Certified  milk,  86 

Chart,  weight,  43 

Chest,  development  of.  13.  45 

Children  at  table,  1 1 7 

requirements  of,  55 
Chicken  pox,  156 
Cholera  infantum,  133 
Cleansing,  first,  15 
Clothes,  material  of,  25 

night,  24 

short,  27 

texture  of,  20 

under,  24 

weight  of,  20 

winter,  25 
Clothing  for  older  children,  30 
Colds,  141 
Colic,  113,  127 

treatment  of,  128 

uric  acid,  127 
Colostrum  milk,  68 
Composition  of  milk,   62,   80, 

107 
Constipation,  40,  128 
Contagious  diseases,  153 
Constrictions,  dangers  from, 

3° 
Convulsions,  133 

cause  of,  149 

effects  of,  152 

symptoms  of,  150 

treatment  for,  151 
Cord,  care  of,  16 
Cow's  milk,  So 
Cows,  care  of,  83 

selection  of,  83 
Croup,  kinds  of,  145 


205 


2o6 


CARE  OF  CHILDREN 


Croup  treatment  for,  146 
Cry,  the,  125 
Crying,  37 

persistent,  126 
Daily  outing,  37 
Diaper,  material  of,  26 
Diarrhea,  summer,  130 
Dietaries  for  children,  116 
Digestion,  completeness  of,  77 

gastric,  76 
Digestive  organs,  13 

secretions,  development    of, 
46 
Diphtheria,  cause  of,  157 

symptoms  of,  157 
Diseases,  contagious,  153 

nervous,  148 

symptoms  of,  123 

table  of  contagious,  162 
Drawers,  28 
Dress  of  mother,  1 
Dressing,  care  in,  27 
Drugs,  use  of,  130 
Earache,  160 
Ear  strain,  170 
Education,  167 
Emotion,  expression  of,  52 
Exercise,  37 
Eye  strain,  170 
Eyes5  care  of,  11,  16 
Fats,  63 
Feeding,  92 

artificial,  76-114,  179 

irregular,  59 

substitute,  71 
Fever,  124 

scarlet,  155 
Fevers,  eruptive,  153 
Fluids,  drain  of,  132 
Fontanelles,  10 
Food,  artificial,  74 

coarse,  129 

disorders,  113 

first  substitute,  73 

for  mother,  3 


Food  for  older  children,  115 

natural,  56 

other  than  milk,  109 

patent,  no 

recipes,  119 

semi-solid,  115 

test  of,  64 

unadvisable,  118 
Foreign  bodies,  159 
Formula,  making  up  a,  104 
Formulas,  changing,  106 
Fruit  juices,  109 
Furnishing  of  nursery,  33 
Games  for  girls,  168 
Genitals,  care  of,  39 
Growth,  relative,  45 
Gruels,  109 
Head,  development  of,  45  , 

shape  of,  9 
Health,  symptoms  in,  123 
Hearing,  development  of,  51 
Height,  table  of.  42 
Hot  weather  diet,  114 
Infant  feeding,  sodium  citrate 
in,  179 

hgyiene,  importance  of,  6 
Kicking,  37 
Kumyss,  122 
Lactation,  period  of,  72 
Length,  gain  in,  44 
Lime  water,  120 
Lungs,  12 
Malnutrition,  cause  of,  139 

treatment  for,  139 
Marasmus,  139 
Massage,  129 
Maternity  gown,  2 
Materials  for  children's  clothes 

Measles,  153 

German,  154 
Medicine  chest,  163 
Meningitis,  160 

Mental  attitude  of  mother,  5, 
66 


INDEX 


207 


Milk,  62,  80 

analysis  of,  102 

certified,  86 

changing  fats  in,  66 

changing  proteids  in,  67 

colostrum,  68 

composition  of,  80 

cow's,  80 

fresh,  89 

home  care  of,  87 

modified,  82,  90 

mother's,  62 

neutralizing  acidity  of,  95 

Pasteurizing,  88 

safe,  82 

sterilizing,  88 

unsafe,  88 
Moccasin  shoe,  28 
Modified  milk,  formulae   for, 

97 

mixing,  103 
Morning  sickness,  3 
Mortality  in  summer,  131 
Mother,  care  of,  1,  70 

dress  of,  1 

food  for,  3 

mental  conditions  of,  5 

milk,  composition  of,  62 
Motor  development,  50 
Mutton  broth,  1 19 
Natural  food,  56 
Nervous  disorders,  148 

system,  14 
Ki^ht  garment,  24 
Nose,  care  of,  144 
Nurse,  wet,  75 
Nursery,  32 

furnishing  of,  33 

location  of,  33 

temperature  of,  33 
Nursing,  control  of,  57 

co-operation  in,  60 

early,  56 

effect  of  frequent,  69 

first,  17 


Nursing,  frequency  of,  58 

position  in,  59 
Nutrition,  of  the  child,  55 
Oil  atomizer,  145 
Outing,  daily,  37 
Overfeeding,  61,  113 
Passages,  abnormal,  134 

normal,  77 
Pasteurizing  milk,  88 
Patent  baby  foods,  no 
Peptonized  milk,  121 
Protection  of  baby,  32 
Proteids,  63 

cause  indigestion,  81 
Proportions  at  birth,  9 
Pubescence,  171 
Quality  of  milk,  variation  in, 

64 
Quantity  of  milk,  variation  in, 

65 
Recipes,  119 

Refrigeration,  of  milk,  86 
Regularity,  40,  130 
Requirements  of  child,  55 
Respiration,  12 
Rickets,  symptoms  of,  137 
Rules  for  eating,  118 
Scalp,  care  of,  19 
Scarlet  fever,  155 
School  hygiene,  171 
Scorbutus,  cause  of,  140 

treatment  for,  141 
Scurvy,  136 

Senses,  development  of,  50 
Shock,  danger  of,  18 
Shoes,  kinds  of,  28 
Short  clothes,  27 
Siphoning  off  milk,  103 
Sitting,  52 
Skin  at  birth,  6 

care  of,  14 
Sleep,  34,  167 
Soap,  quality  of,  19 
Soidum  citrate  in  infant  feed- 
ing, 179 


208 


CARE  OF  CHILDREN 


Soother,  the,  35,  192 
Sore  throat,  142 
Spasms,  cause  of,  149 
Special  senses  at  birth,  15 
Spine,  condition  at  birth,  11 
Standing,  52 
Starch  as  food,  109 
Sterilizing  milk,  88 
Stimulants,  118 
Stomach,  capacity  of,  46 
Stools,  color  of,  135 
Substitute  feeding,  essentials 

in,  78 
Sucking  cushions,  1 1 

thumb,  36 
Sugar,  63,  10 1 
Summer  complaint,  130 

after  effects,  134 
Surroundings  and  care,  32 
Symptoms  in  health,  123 
Syringe,  use  of,  159 
Taste,  development  of,  50 
Teeth,  care  of,  39,  165 

examination  of,  5 

milk,  47 

order  of  eruption,  47 

permanent,  48 
Teething,  47 

retarded,  50 
Temperature,  20,  147 

of  baths,  38 


Temperature  of  nursery, 

33 

variations  in,  147 
Thirst,  61 

Throat,  care  of,  166 
Thumb  sucking,  36 
Under  clothes,  24 
Unsafe  milk,  88 
Uric  acid,  62 
Urine,  examination  of,  4 
Viscous  circle,  36 
Vision,  development  of,  51 
Vomiting,  113,  132 

cause  of,  71 
Walking,  52 

Water  bath,  first  general,  18 
Water,  importance  of,  62 
Weak  heart,  period  of,  i6(> 
Weaning,  71 

early,  72 

time  of  year,  73 
Weight  at  birth,  9 

chart,  43 

loss  of,  57 

rate  of  increase  in,  43 

table  of,  42 
Wet  nurce  75 
Whey,  120 
Whining,  126 
Whooping  cough,  15S 
Winter  clothes,  25 


This  book  is  DUE  on  the  last  date  stamped  below 


JUL  81  1929 

W0V2  9  1938 

**«  21  1545 
'JUL  9-  1958 

JUN 1  8  RCCtl 

tffiME&MAY  1 4  73 

BtONE°  ^B- 

SEP    8  REM 


Form  L-9-10m-5,'28 


Vxi, 


3  1158  00555  2343 


A     000  356  150     3 


kh  SCHOOL 

CALIFORNIA 


